[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
EXAMINING ADVERTISING AND MARKETING
PRACTICES WITHIN THE SUBSTANCE USE TREATMENT INDUSTRY
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
JULY 24, 2018
__________
Serial No. 115-155
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
__________
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COMMITTEE ON ENERGY AND COMMERCE
GREG WALDEN, Oregon
Chairman
JOE BARTON, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
FRED UPTON, Michigan BOBBY L. RUSH, Illinois
JOHN SHIMKUS, Illinois ANNA G. ESHOO, California
MICHAEL C. BURGESS, Texas ELIOT L. ENGEL, New York
MARSHA BLACKBURN, Tennessee GENE GREEN, Texas
STEVE SCALISE, Louisiana DIANA DeGETTE, Colorado
ROBERT E. LATTA, Ohio MICHAEL F. DOYLE, Pennsylvania
CATHY McMORRIS RODGERS, Washington JANICE D. SCHAKOWSKY, Illinois
GREGG HARPER, Mississippi G.K. BUTTERFIELD, North Carolina
LEONARD LANCE, New Jersey DORIS O. MATSUI, California
BRETT GUTHRIE, Kentucky KATHY CASTOR, Florida
PETE OLSON, Texas JOHN P. SARBANES, Maryland
DAVID B. McKINLEY, West Virginia JERRY McNERNEY, California
ADAM KINZINGER, Illinois PETER WELCH, Vermont
H. MORGAN GRIFFITH, Virginia BEN RAY LUJAN, New Mexico
GUS M. BILIRAKIS, Florida PAUL TONKO, New York
BILL JOHNSON, Ohio YVETTE D. CLARKE, New York
BILLY LONG, Missouri DAVID LOEBSACK, Iowa
LARRY BUCSHON, Indiana KURT SCHRADER, Oregon
BILL FLORES, Texas JOSEPH P. KENNEDY, III,
SUSAN W. BROOKS, Indiana Massachusetts
MARKWAYNE MULLIN, Oklahoma TONY CARDENAS, California
RICHARD HUDSON, North Carolina RAUL RUIZ, California
CHRIS COLLINS, New York SCOTT H. PETERS, California
KEVIN CRAMER, North Dakota DEBBIE DINGELL, Michigan
TIM WALBERG, Michigan
MIMI WALTERS, California
RYAN A. COSTELLO, Pennsylvania
EARL L. ``BUDDY'' CARTER, Georgia
JEFF DUNCAN, South Carolina
Subcommittee on Oversight and Investigations
GREGG HARPER, Mississippi
Chairman
H. MORGAN GRIFFITH, Virginia DIANA DeGETTE, Colorado
Vice Chairman Ranking Member
JOE BARTON, Texas JANICE D. SCHAKOWSKY, Illinois
MICHAEL C. BURGESS, Texas KATHY CASTOR, Florida
SUSAN W. BROOKS, Indiana PAUL TONKO, New York
CHRIS COLLINS, New York YVETTE D. CLARKE, New York
TIM WALBERG, Michigan RAUL RUIZ, California
MIMI WALTERS, California SCOTT H. PETERS, California
RYAN A. COSTELLO, Pennsylvania FRANK PALLONE, Jr., New Jersey (ex
EARL L. ``BUDDY'' CARTER, Georgia officio)
GREG WALDEN, Oregon (ex officio)
C O N T E N T S
----------
Page
Hon. Gregg Harper, a Representative in Congress from the State of
Mississippi, opening statement................................. 1
Prepared statement........................................... 3
Hon. Diana DeGette, a Representative in Congress from the state
of Colorado, opening statement................................. 4
Prepared statement........................................... 6
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 7
Prepared statement........................................... 8
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 10
Prepared statement........................................... 11
Witnesses
Marvin Ventrell, Executive Director, National Association of
Addiction Treatment Providers.................................. 13
Prepared statement........................................... 15
Mark Mishek, President and CEO, Hazelden Betty Ford Foundation... 26
Prepared statement........................................... 28
Michael Cartwright, Chairman and CEO, American Addiction Centers. 38
Prepared statement........................................... 40
Robert Niznik, CEO, Addiction Recovery Now and Niznik Behavioral
Health......................................................... 43
Prepared statement........................................... 45
Jason Brian, Founder, Redwood Recovery Solutions and
Treatmentcalls.Com............................................. 49
Prepared statement........................................... 52
Kenneth Stoller, Director, Johns Hopkins Hospital Broadway Center
for Addiction.................................................. 56
Prepared statement........................................... 58
Submitted Material
Subcommittee memorandum.......................................... 94
List of websites, submitted by Ms. DeGette....................... 102
Letter of July 24, 2018, from the Federal Trade Commission to
Members of the Committee, submitted by Ms. DeGette............. 105
EXAMINING ADVERTISING AND MARKETING PRACTICES WITHIN THE SUBSTANCE USE
TREATMENT INDUSTRY
----------
TUESDAY, JULY 24, 2018
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:00 a.m., in
room 2123, Rayburn House Office Building, Hon. Gregg Harper
(chairman of the subcommittee) presiding.
Present: Representatives Harper, Griffith, Burgess, Brooks,
Collins, Walberg, Walters, Costello, Carter, Walden (ex
officio), DeGette, Schakowsky, Castor, Tonko, Clarke, Ruiz, and
Pallone (ex officio).
Also Present: Representative Bilirakis.
Staff Present: Jennifer Barbla, Chief Counsel, Oversight
and Investigations; Adam Fromm, Director of Outreach and
Coalitions; Ali Fulling, Legislative Clerk, Oversight and
Investigations, Digital Commerce and Consumer Protection;
Brighton Haslett, Counsel, Oversight and Investigations;
Brittany Havens, Professional Staff, Oversight and
Investigations; Ed Kim, Policy Coordinator, Health; Andrea
Noble, Fellow, Oversight and Investigations; Jennifer Sherman,
Press Secretary; Austin Stonebraker, Press Assistant; Hamlin
Wade, Special Advisor, External Affairs; Everett Winnick,
Director of Information Technology; Julie Babayan, Minority
Counsel; Jeff Carroll, Minority Staff Director; Waverly Gordon,
Minority Health Counsel; Zach Kahan, Minority Outreach and
Member Services Coordinator; Chris Knauer, Minority Oversight
Staff Director; Jourdan Lewis, Minority Staff Assistant; Miles
Lichtman, Minority Policy Analyst; Perry Lusk, Minority
Government Accountability Office Detailee; Kevin McAloon,
Minority Professional Staff Member; and C.J. Young, Minority
Press Secretary.
OPENING STATEMENT OF HON. GREGG HARPER, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF MISSISSIPPI
Mr. Harper. The subcommittee will come to order.
Today, the subcommittee holds a hearing entitled examining,
advertising, and marketing practices within the substance abuse
treatment industry. This hearing builds on the subcommittee's
extensive work over the past 4 years examining the causes and
scope of the opioid epidemic including ways to effectively
treat individuals with a substance use disorder.
The opioid epidemic continues to ravish our nation.
According to the Centers for Disease Control approximately, 2.1
million Americans over the age of 12 suffer from an opioid use
disorder. Meanwhile, the number of Americans dying from opioid
overdoses has increased in recent years to 115 deaths per day.
As the opioid epidemic continues to take its toll, the
demand for treatment has dramatically increased. According to
the Substance Abuse and Mental Health Services Administration,
the number of treatment facility admissions for opiate use
increased 58 percent from 2005 through 2015. With rising
demand, the number of treatment facilities has also grown.
However, the increased demand for treatment and attendant
proliferation of treatment facilities has raised a number of
concerns about practices within the industry.
Our December hearing examined ``patient brokering,'' the
practice of recruiting individuals with a substance use
disorder and luring them to treatment facilities and sober
living homes, often in other States, in return for financial
kickbacks. We also heard testimony about the problems stemming
from the dramatic surge and substance use disorder treatment
facilities including practices employed by businesses known
generally as ``call aggregators.'' These practices incentivize
profit over the recovery and well-being of the individual
seeking treatment.
The information we learned at the hearing in December,
along with additional reports and research that the Committee
conducted, led us to dig deeper into these marketing and
advertising practices within the drug treatment industry.
If you compare how one seeks care for a substance use
disorder to how one would seek care for any other illness or
disease, the differences are staggering. For example, if you
aren't feeling well, most people would go to their primary care
physician, or if it's an emergency, the ER, and that doctor is
likely to refer you to another doctor or specialist, depending
upon what's wrong. Here, individual seeking treatment for
themselves or loved one often turn to the Internet to find
resources to guide them in choosing a treatment center. One
study found that 61 percent of people who went to rehab used
the Internet to find treatment. Such online searches can prove
overwhelming. Patients are often at the mercy of what they find
online with little or no guidance from a medical professional.
Many treatment-focused websites advertise hotlines that
purport to direct individuals to a trained professional that
can help the individual assess what treatment facilities will
best meet their needs. These call centers may appear to be
unaffiliated third-party referral services, but they are often
either owned and operated by treatment facilities or are paid
by facilities to refer calls. While some centers disclose their
relationship with treatment facilities, others may engage in
deceptive marketing tactics to hide them. Moreover, these call
centers are often staffed by sales representatives rather than
medical professionals. In some cases, the individual staffing
the company's call center receive a bonus each month based on
the number of callers that are successfully admitted into one
company's facilities.
In some of the worst cases, call aggregators, or call
centers, may refer patients to facilities that don't meet their
needs based on a financial arrangement. And once patients enter
treatment, they may be vulnerable to exploitation by
unscrupulous business owners.
Concerns raised about deceptive advertising and marketing
practice have already led to action. For example, several
States have passed legislation, the National Association For
Addiction Treatment Providers updated its code of ethics, and
Google placed a temporary restriction of online advertising by
treatment providers due to misleading experiences among
rehabilitation treatment centers.
As the opioid epidemic continues to claim lives, it is
vital that we ensure individuals seeking treatment for
themselves or loved ones are able to find treatment that best
meets their needs without being misled by those who would
prioritize financial gain over saving lives.
We thank our panel of witnesses for joining us this
morning. I hope that today's hearing will shed light on how we
can combat deceptive marketing practices while protecting
legitimate treatment centers and the individuals desperately
seeking their care.
We thank you for appearing before the subcommittee today,
and we will look forward to hearing your testimony shortly.
At this time, the chair will recognizes the ranking member
of this subcommittee Ms. DeGette for 5 minutes for the purposes
of an opening statement.
[The prepared statement of Mr. Harper follows:]
Prepared statement of Hon. Gregg Harper
The Subcommittee will come to order. Today the Subcommittee
holds a hearing entitled ``Examining Advertising and Marketing
Practices within the Substance Use Treatment Industry.'' This
hearing builds on the Subcommittee's extensive work over the
past four years examining the causes and scope of the opioid
epidemic, including ways to effectively treat individuals with
a substance use disorder.
The opioid epidemic continues to ravage our nation.
According to the Centers for Disease Control, approximately 2.1
million Americans over the age of 12 suffer from an opioid use
disorder. Meanwhile, the number of Americans dying from opioid
overdoses has increased in recent years to 115 deaths each day.
As the opioid epidemic continues to take its toll, the
demand for treatment has dramatically increased. According to
the Substance Abuse and Mental Health Services Administration,
the number of treatment facility admissions for opiate use
increased 58 percent between 2005 and 2015. With rising demand,
the number of treatment facilities has also grown. However, the
increased demand for treatment and attendant proliferation of
treatment facilities have raised a number of concerns about
practices within the industry.
Our December hearing examined ``patient brokering,'' the
practice of recruiting individuals with a substance use
disorder and luring them to treatment facilities and sober
living homes, often in other states, in return for financial
kickbacks. We also heard testimony about the problems stemming
from the dramatic surge in substance use disorder treatment
facilities, including practices employed by businesses known
generally as ``call aggregators.'' These practices incentivize
profit over the recovery and well-being of the individual
seeking treatment.
The information we learned at the hearing in December,
along with additional reports and research that the Committee
conducted, led us to dig deeper into these marketing and
advertising practices within the drug treatment industry.
If you compare how one seeks care for a substance use
disorder to how one would seek care for any other illness or
disease, the difference is staggering. For example, if you
aren't feeling well most people would go to their primary care
doctor or if it's an emergency, the ER, and that doctor is
likely to refer you to another doctor or specialist depending
on what's wrong. Here, individuals seeking treatment for
themselves or a loved one often turn to the internet to find
resources to guide them in choosing a treatment center--one
study found that 61 percent of people who went to rehab used
the internet to find treatment. Such online searches can prove
overwhelming, patients are often at the mercy of what they find
online with little or no guidance from a medical professional.
Many treatment-focused websites advertise hotlines that
purport to direct individuals to a trained professional that
can help the individual assess what treatment facility will
best meet their needs. These call centers may appear to be
unaffiliated third-party referral services, but they are often
either owned and operated by treatment facilities or are paid
by facilities to refer calls. While some centers disclose their
relationship with treatment facilities, others may engage in
deceptive marketing tactics to hide them. Moreover, these call
centers are often staffed by sales representatives rather than
medical professionals. In some cases, the individuals staffing
the company's call center receive a bonus each month based on
the number of callers that are successfully admitted into one
of the company's facilities.
In some of the worst cases, call aggregators or call
centers may refer patients to facilities that don't meet their
needs based on a financial arrangement and once patients enter
treatment they may be vulnerable to exploitation by
unscrupulous business owners.
Concerns raised about deceptive advertising and marketing
practices have already led to action. For example, several
states have passed legislation, the National Association for
Addiction Treatment Providers updated its code of ethics, and
Google placed a temporary restriction of online advertising by
treatment providers due to ``misleading experiences among
rehabilitation treatment centers.''
As the opioid epidemic continues to claim lives, it is
vital that we ensure individuals seeking treatment for
themselves or loved ones are able to find treatment that best
meets their needs without being misled by those who would
prioritize financial gain over saving lives.
We thank our panel of witnesses for joining us this
morning. I hope that today's hearing will shed light on how we
can combat deceptive marketing practices while protecting
legitimate treatment centers and the individuals desperately
seeking their care.
We thank you for appearing before the Subcommittee today
and look forward to hearing your testimony.
OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Ms. DeGette. Thank you very much, Mr. Chairman.
Mr. Chairman, throughout the several years that we have
been holding a series of hearings in this subcommittee and
other subcommittees of the Energy and Commerce Committee, one
of the themes that has emerged is that families need good
information about the types of treatments that are available.
And also we've heard from the medical experts that evidence-
based treatment, including medication-assisted treatment is the
most effective means for overcoming opioid use disorders.
But this is echoing what your concern is. Not all
facilities provide that treatment. Some facilities make only
vague promises about the effectiveness of various treatment
models they offer. And in addition, when you're finding your
facility online, most patients will have no idea if the
facilities that they're identifying would have the types of
treatment that would actually work in dealing with this opioid
crisis.
We've been seeing through this committee's investigation
that we've got nefarious or unqualified actors out there who
are taking advantage of those who are suffering in order to
capitalize on this condition.
Last year, this subcommittee had a hearing where we heard
about individuals known as ``patient brokers'' who profit from
recruiting patients with opioid addiction and then send them to
dubious treatment centers in other States.
We have heard that the operators of many of these centers
sometimes have no training or expertise in drug treatment and
once the patients arrive, they may receive substandard or no
care at all. And then in December, the subcommittee heard from
law enforcement officials in States that were affected by these
schemes.
They testified about the wide variation and the quality of
care provided at some of the facilities and how we lack
sufficient national standards.
Now, today, we're looking at another feature of the opioid
epidemic that shows the challenges patients with opioid use
disorder currently face. And that is, how the treatment
providers advertise, market, or locate prospective patients
seeking treatment and guide them to appropriate treatment.
In other words, are patients prioritized when it comes to
finding and directing those seeking care for opioid use
disorders and for those patients who are the target of
aggressive marketing practices, how should they evaluate a
possible treatment facility for its effectiveness?
As you noted, Mr. Chairman, this committee has seen reports
of call centers that sell customer referrals to treatment
providers. Some also hide the fact that they're making
referrals for a fee or that the call centers actually owned by
the same company that owns the treatment center.
We've also seen aggressive advertising and marketing
strategies by treatment facilities such as websites and 1-800
numbers that do not clearly disclose who a patient is
contacting or where they're being referred. And some facilities
try to lure in patients with promises of luxurious treatment
such as daily yoga sessions and free housing. And I think that
the experts who are here today will tell you that things like
daily yoga sessions, while they might be great for a spa, are
not going to cure opioid addiction.
So how pervasive are these problems in the industry, and
how many of these practices, like having multiple websites or
purchasing calls in bulk, actually provide the treatment that
helps people recover?
So for today's discussion, here is what I'm looking to hear
from the witnesses: What are good practices when it comes to
marketing treatment services and what are dubious practices?
We need to hear whether there are certain quality
indicators patients should look for when seeking a treatment
and just as important, are there certain red flags that
indicate questionable services?
In other words, Mr. Chairman, opioid use disorder and its
treatment is complicated enough for any prospective patient to
navigate.
We need to make sure that existing practices are not making
it more difficult for people seeking treatment by obscuring
what's really being provided and what they need to treat their
addiction.
And so we need to find out how treatment providers find
patients, educate them, and then guide them into appropriate
treatment.
I look forward to hearing from all of the witnesses about
these issues, and I yield back.
[The prepared statement of Ms. DeGette follows:]
Prepared statement of Hon. Diana DeGette
Thank you, Mr. Chairman.
We have all heard the statistics about the opioid crisis:
the thousands who die each year, and millions more who are
suffering from addiction.
But through this committee's investigation, we have seen
another side of this crisis: some nefarious or unqualified
actors are taking advantage of those who are suffering, out of
the desire to capitalize on their condition.
As the Committee learned last year, some individuals known
as ``patient brokers'' profit from recruiting patients with
opioid addiction, and then send them to dubious treatment
centers in other states. We heard that the operators of many of
these centers sometimes have no training or expertise in drug
treatment, and once the patients arrive, they may receive sub-
standard or no care at all.
This past December, the subcommittee heard from law
enforcement officials in States affected by these schemes. They
testified about the wide variation in the quality of care
provided at some facilities, and how we lack consistent
standards.
Today we are examining another feature of the opioid
epidemic that again shows some of the challenges patients with
opioid use disorder currently face. And that is how treatment
providers advertise, market, or locate prospective patients
seeking treatment and guide them to appropriate treatment.
In other words, are patients prioritized when it comes to
finding and directing those seeking care for opioid use
disorders? And for those patients who are the target of
aggressive marketing practices, how should they evaluate a
possible treatment facility for its effectiveness?
This Committee has seen reports of call centers, for
example, that sell customer referrals to treatment providers.
Some also hide the fact that they are making referrals for a
fee, or that the call center is owned by the same company that
owns the treatment center.
We have also seen aggressive advertising and marketing
strategies by treatment facilities, such as websites and 1-800
numbers that do not clearly disclose who a patient is
contacting or where they're being referred. Some facilities
also try to lure in patients with promises of luxurious
treatment, such as daily yoga sessions and free housing.
How pervasive are these problems in the industry, and how
do many of these practices--such as having multiple websites or
purchasing calls in bulk--actually help individuals recover?
For today's discussion, the witnesses need to articulate
what they regard as good practices when it comes to marketing
treatment services, and what they regard as dubious practices.
Also, are there certain quality indicators that patients should
look for when seeking a treatment option? As importantly, are
there certain red flags that indicate questionable services?
In other words, Mr. Chairman, opioid use disorder and its
treatment is complicated enough for any prospective patient to
navigate. We must make sure that existing practices are not
making it harder for those seeking treatment by obscuring
what's really being provided and what they need to treat their
addiction.
So today we have questions regarding how treatment
providers find patients, educate them, and then guide them into
appropriate treatment.
The witnesses today can articulate how they do these things
before referring or accepting a patient. And hopefully, they
will also describe how pervasive certain questionable tactics
are regarding treatment offerings.
Mr. Chairman, one of the themes that has emerged in our
years-long examination of the opioid crisis is that families
need much better information about the types of treatment
available.
This Committee has long heard from the medical experts that
evidence-based treatment- including medication-assisted
treatment-is the most effective method for overcoming opioid
use disorder. But not all facilities provide that treatment,
and some make vague promises about the effectiveness of the
various treatment models they offer.
Our witnesses today can provide a benchmark of what they
regard as quality treatment, and how that compares to some of
the questionable treatment facilities we have seen reports
about. This is critical because if patients don't know what to
look for when they are seeking care, it is even easier for bad
actors to take advantage of them.
Mr. Chairman, the effects of the opioid crisis will be with
us for decades. It is going to take a monumental effort by the
medical community, public health agencies, Congress, and this
Committee to climb out. That will be challenging enough. But in
the process, we cannot let bad or ineffective actors make the
problem even worse.
I hope this Committee can shed some light on these problems
and provide the tools and resources for people to get the
treatment they need.
I yield back.
Mr. Harper. The gentlewoman yields back.
The chair will now recognize the chairman of the full
committee, Greg Walden for the purposes of his opening
statement.
OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. Thank you very much, Mr. Chairman. I appreciate
you holding this hearing.
I want to thank our witnesses for being here today to
inform our work.
Today's hearing follows up on our year-long bipartisan
investigation to patient brokering and the fraud and abuse
within the substance use disorder treatment industry.
Beginning in April of 2014, this subcommittee commenced a
comprehensive examination into the causes of the opioid
epidemic, the impact it's had on Americans and explored
possible solutions to enable greater access to effective
evidence-based treatment for substance use disorders.
The House, as you know, recently passed H.R. 6. This is the
Support For Patients and Communities Act, which includes 70
provisions, largely from this committee, that seek to address a
number of issues within the opioid epidemic. But our work here
is not done. The committee continues to conduct its proper
oversight, because our Nation is far from seeing the end of the
opioid epidemic and its tragic and deadly effects.
In December, the subcommittee held a hearing examining the
patient brokering and addiction treatment fraud where concerns
were raised about deceptive and sometimes predatory advertising
and marketing practices within the treatment industry.
In addition, we've read news reports, spoken to treatment
facilities, doctors, associations and stakeholders within the
industry, but most importantly, we've heard from individuals,
their loved ones, who have faced some of these aggressive and
deceptive advertising practices. In fact, in my own district
out in Oregon, a father named Mike told me about the troubling
experience he had when his son was seeking treatment for
addiction. The recovery center that his son went to was located
in another State. And he said it seemed more interested in
cashing the check than actually caring for his son.
As the committee dove deeper into the advertising and
marketing practices within this industry, we found a Pandora's
box of online advertisement, websites, phone numbers, lead
generators, call centers, and television commercials. In some
cases an individual or company may own dozens and dozens of
websites, and some of these websites contain different 1-800
numbers, despite all being owned by the same person were all
leading to the same treatment company.
Some websites and television commercials used pretty
forceful language, such as, ``Call now, don't wait any
longer,'' ``Get the help you need,'' ``Talk to someone who
cares,'' ``End your addiction now,'' or ``For immediate
treatment help.'' One individual the committee spoke with
shared that the person on the other end of the phone went on to
say, ``if you don't get your kid here now, your kid will die.''
Further, some of the websites and advertisements purport to
offer the ``best'' treatment in the country or claim high
success rates to lure patients to their facilities. This all
sounds great. We don't know what those statements are based
upon. For example, does that mean someone successfully enrolled
in the treatment, completed treatment, that they are still
maintaining their sobriety one year later? What does success
mean, and how do you measure it? These are the types of
questions that individuals and their loved ones should be able
to find answers for when they search their treatment that best
meets their needs.
These advertising practices lead to reputable and quality
treatment. That's great. That's what we hope for. But deceptive
practices can have consequences, whether it's online
advertisements, websites, 1-800 numbers, or television
commercials, individuals and their loved ones should be able to
expect transparency, know who answers the phone or responds to
an inquiry when they reach out for help. Individuals who call
treatment hotlines are often in times of crisis and they had
need help fast and from someone that can be trusted. They have
a right to know what facilities they're calling and the type of
treatment that facility offers so they can decide whether it's
the right treatment for them or their loved one.
So today's hearing will help bring much-needed attention to
this issue, help us understand the scope of advertising and
marketing practices within the treatment issue. Our hope is a
thoughtful discussion will help us establish a baseline for
best practices, help inform individuals or loved ones about how
to seek treatment that best meets their needs.
And I would yield the balance of the time to the chairman
of the Subcommittee of Health, Dr. Burgess.
[The prepared statement of Mr. Walden follows:]
Prepared statement of Hon. Greg Walden
Thank you, Mr. Chairman, for holding this hearing. Today's
hearing follows up on a year-long bipartisan investigation into
patient brokering and the fraud and abuse within the substance
use disorder treatment industry.
Beginning in April 2014, this subcommittee commenced a
comprehensive examination into the causes of the opioid
epidemic, the impact it's had on Americans, and explored
possible solutions to enable greater access to effective,
evidence-based treatment for substance use disorders.
The House recently passed H.R. 6, the SUPPORT for Patients
and Communities Act, which includes 70 provisions--largely from
this committee--that seek to address a number of issues within
the opioid crisis. But our work here is not done and the
committee continues to conduct oversight because our country is
far from seeing the end of the opioid epidemic and its tragic
effects.
In December, this subcommittee held a hearing examining
patient brokering and addiction treatment fraud where concerns
were raised about deceptive and sometimes predatory advertising
and marketing practices within the treatment industry.
In addition, we've read news reports, spoken to treatment
facilities, doctors, associations, and stakeholders within the
industry, but most importantly, we've heard from individuals
and their loved ones who have faced some of these aggressive
and deceptive advertising practices. In my district in Oregon,
a father named Mike told me about the troubling experience he
had when his son was seeking treatment for addiction. The
recovery center was located in another stated and seemed more
interested in cashing a check rather than caring for his son.
As the committee dove deeper into the advertising and
marketing practices within this industry we found a Pandora's
box of online advertisements, websites, phone numbers, lead
generators, call centers, and television commercials. In some
cases, an individual or company may own dozens and dozens of
websites, and some of these websites contain different 1-800
numbers, despite all being owned by the same person or all
leading to the same treatment company.
Some websites and television commercials use forceful
language, such as: ``Call now,'' ``don't wait any longer,''
``get the help you need,'' ``talk to someone who cares,'' ``end
your addiction now,'' or ``for immediate treatment help.'' One
individual the committee spoke with shared that the person on
the other end of the phone went as far to say, ``if you don't
get your kid here now, your kid will die.''
Further, some of the websites and advertisements purport to
offer the ``best'' treatment in the country or claim high
success rates to lure patients to their facilities. This all
sounds great, but we don't know what those statements are based
on. For example, does that mean someone successfully enrolled
in treatment, completed treatment, that they are still
maintaining their sobriety one year later? What does success
mean and how do you measure it? These are the types of
questions that individuals and their loved ones should be able
to find answers for when they search for treatment that best
meets their needs.
If these advertising practices lead to reputable and
quality treatment, that's great. But, these deceptive practices
can have consequences. Whether it's online advertisements,
websites, 1-800 numbers, or television commercials--individuals
and their loved ones should be able to expect transparency and
know who answers the phone or responds to an inquiry when they
reach out for help. Individuals who call treatment hotlines are
often in a time of crisis and they need help fast and from
someone they can trust. They have a right to know what facility
they are calling and the type of treatment that facility offers
so they can decide whether it is the right treatment for them
or their loved one.
Today's hearing will help bring much needed attention to
this issue and help us understand the scope of advertising and
marketing practices within the treatment industry. Our hope is
that a thoughtful discussion will help us establish a baseline
for best practices and help inform individuals and their loved
ones about how to seek treatment that best meets their needs.
I welcome our witnesses and look forward to their
testimony.
Mr. Burgess. I thank the chairman for yielding. And the
chairman makes an important point. H.R. 6 did pass through this
committee and, indeed, on the floor of the House. And we do
call on the Senate, the other body, to take that up.
This is not the first hearing we've had on this subject.
Last December, we did have a hearing, and we heard from the
assistant attorney general from the Massachusetts attorney
general's office, Eric Gold, was his name. And he provided for
us three recommendations on the evaluation and solution for the
problems that are existing at sober homes.
He said we need additional resources for Federal, State and
local law enforcement. OK, that's covered in H.R. 6. Second,
patients need transparency into the quality of addiction
treatment of the providers nationwide. I agree with that. I'm
not sure we're there. And the third thing: We need to ensure
that patients with substance use disorder have access to the
treatment they need and we do not unintentionally limit access.
And that is an important point as well.
Additionally, we heard from a panel of family members who
had been affected by family members who had problems with
opioid addiction. And one of the statements of one of the
witnesses really stands out.
She said, ``the intent, of course, was not to kill Jaime,
but to keep him in the system and continue to abuse his
insurance.''
Those are pretty apocryphal words, and I hope we get to
explore some more of that. Mr. Chairman, thank you for the
indulgence, and I yield back Mr. Walden's time.
Mr. Harper. The gentleman yields back. The chair will now
recognize the ranking member of the full committee, Mr.
Pallone, for 5 minutes.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Mr. Chairman.
The opioid epidemic continues to devastate families and
communities around the Nation. We still have a long way to go
to climb out of this crisis. Opiates killed more than 115
Americans a day in 2016, and millions more continue to suffer.
That's bad enough, but to see people taking advantage of this
crisis by preying on victims to make money is unconscionable.
The Affordable Care Act expanded access to substance abuse
treatment for millions of Americans. It also required insurance
companies to cover this treatment just as they would cover any
other chronic disease. Thanks to the ACA and Medicaid
expansion, Americans who could not get access to this treatment
before, now can. Unfortunately, people with substance use
disorder still face barriers to accessing treatment. According
to SAMHSA, of the 19 million adults who had a substance use
disorder in 2016, 17 million did not receive treatment.
We need to do everything we can to help more Americans
access this treatment. Unfortunately, there are companies
preying on individuals in desperate need of treatment services.
Some of the companies this committee has been examining claim
they are merely filling a market need, but anyone advertising
treatment services must put the needs of the patient first, and
they must employ well qualified staff that can provide quality
treat or ensure that they are only referring patients to
quality treatment providers.
This committee's investigation into patient brokering
revealed shocking examples of companies that claim to offer
treatment and special perks to individuals suffering from
opioid addiction. Families that were desperate to help their
loved ones put their trust and hope in many of these treatment
facilities. But as our investigation has found, many of those
entities are a scam, and do not offer actual treatment. In some
instances, these facilities are actually putting people's lives
at risk.
Now the Committee has broadened its focus to look at
treatment call centers and marketing tactics. And
unfortunately, we've discovered that some companies have looked
at this devastating epidemic as an opportunity solely to make
money.
For instance, reports indicate that some of these call
centers or ``call aggregators'' advertise opioid treatment to
get people to call looking for help, and then sell those calls
to various facilities. And it is unclear how this helps the
patient.
Other companies actually appear to offer treatment for
opioid use disorder, but they also engage in aggressive
marketing tactics. For example, some facilities operate
multiple websites with different names and phone numbers, with
the goal of maximizing the number of beds filled.
And this raises questions about how transparent these
companies are about the services they offer and how they help
patients find the treatment that's right for them. It also
raises questions about how a prospective patient is supposed to
navigate the countless number of treatment offerings and find
quality care against the backdrop of the array of services
being advertised.
So I'm hopeful our witnesses can shed some light on the
types of marketing and treatment practices that are best
designed to put the patient first and help them find quality
care.
And unless someone else wants my time, I yield back, Mr.
Chairman.
[The prepared statement of Mr. Pallone follows:]
Prepared statement of Hon. Frank Pallone, Jr.
The opioid epidemic continues to devastate families and
communities around the nation. We still have a long way to go
to climb out of this crisis. Opioids killed more than 115
Americans a day in 2016, and millions more continue to suffer.
That is bad enough--but to see people taking advantage of this
crisis by preying on victims to make money is unconscionable.
The Affordable Care Act expanded access to substance abuse
treatment for millions of Americans, and it also required
insurance companies to cover this treatment just as they would
cover any other chronic disease. Thanks to the ACA and Medicaid
Expansion, Americans who could not get access to this treatment
before now can. Unfortunately, people with substance use
disorder still face barriers to accessing treatment. According
to SAMHSA, of the 19 million adults who had a substance use
disorder in 2016, 17 million did not receive treatment.
We need to do everything we can to help more Americans
access this treatment. Unfortunately, there are companies
preying on individuals in desperate need of treatment services.
Some of the companies this Committee has been examining claim
they are merely filling a market need. But anyone advertising
treatment services must put the needs of the patient first, and
they must employ well-qualified staff that can provide quality
treatment or ensure that they are only referring patients to
quality treatment providers.
This Committee's investigation into patient brokering
revealed shocking examples of companies that claimed to offer
treatment and special perks to individuals suffering from
opioid addiction. Families that were desperate to help their
loved ones put their trust and hope in many of these treatment
facilities. But as our investigation has found, many of those
entities are a scam and do not offer actual treatment. In some
instances, these facilities are actually putting people's lives
at risk.
Now the Committee has broadened its focus to look at
treatment call centers and marketing tactics. And
unfortunately, we've discovered that some companies have looked
at this devastating epidemic as an opportunity solely to make
money.
For instance, reports indicate that some of these call
centers or ``call aggregators'' advertise opioid treatment to
get people to call looking for help, and then sell those calls
to various facilities. It is unclear how this helps the
patient.
Other companies actually appear to offer treatment for
opioid use disorder, but they also engage in aggressive
marketing tactics. For example, some facilities operate
multiple websites with different names and phone numbers, with
the goal of maximizing the number of beds filled.
This raises questions about how transparent these companies
are about the services they offer, and how they help patients
find the treatment that's right for them. It also raises
questions about how a prospective patient is supposed to
navigate the countless number of treatment offerings and find
quality care against the backdrop of the array of services
being advertised.
I am hopeful our witnesses can shed some light on the types
of marketing and treatment practices that are best designed to
put the patient first and help them find quality care.
For example, Dr. Kenneth Stoller from the Johns Hopkins
Hospital Broadway Center for Addiction can tell us about how
they conduct outreach to individuals who may be in need of
substance use disorder services and enroll patients seeking
care. He can also tell us about how treatment providers should
clinically assess the needs of each patient to determine the
best course of treatment, and the role of medication-assisted
treatment (or MAT) for opioid addiction.
I also look forward to hearing from some of the other
treatment providers on their marketing and treatment practices
to understand if they are designed to always put the patient
first and guide them to the care most appropriate for their
condition.
This is important considering that not all families seeking
help have access to objective information or even know what to
look for in evaluating treatment options.
And this problem is especially complicated when families
stumble upon misleading or confusing websites, designed not to
educate people about the best forms of treatment available. So
we need to hear from the panel about what they regard as
quality care, and what a family in crisis should look for in a
treatment program as they struggle to find help with their
addiction.
I support efforts that get more people into quality
treatment. Marketing and advertising can be important tools in
educating people about the different treatment options
available to meet their needs, but if these companies want to
be in the treatment business, they simply must put the patient
first. And this Committee must continue to work to ensure that
any American suffering from this terrible disorder gets the
treatment they need.
Thank you, I yield back.
Mr. Harper. The gentleman yields back.
I ask unanimous consent that the members' written opening
statements be made a part of the record.
Without objection, so ordered.
Additionally, I ask unanimous consent that Energy and
Commerce members not on the subcommittee on Oversight and
Investigations be permitted to participate in today's hearing.
Without objection, so ordered.
I would now like to introduce our witnesses for today's
hearing.
Today, we have Dr.Marvin Ventrell, who is the Executive
Director of the National Association of Addiction Treatment
Providers. Next, is Mr. Mark Mishek, President and CEO of the
Hazelden Betty Ford Foundation. Third, is Mr. Michael
Cartwright, who is the Chairman and CEO of American Addiction
Centers. Mr. Robert Niznik, who is the CEO of Addiction
Recovery Now and Niznik Behavorial Health. Then we have Mr.
Jason Brian, Founder of Redwood Recovery Solutions and
TreatmentCalls.com. And finally, Dr.Kenneth Stoller, who serves
as the Director of John Hopkins Hospital Broadway Center For
Addiction.
We welcome each of you here.
You are all aware that the Committee is holding an
investigative hearing. And when doing so, we have had the
practice of taking testimony under oath.
Do any of you have any objection to testifying under oath?
Every witness has replied no.
The chairman then advises you that under the rules of the
House and the rules of the committee, you are entitled to be
accompanied by counsel.
Do you desire to be accompanied by counsel during your
testimony today?
Let the record reflect that all the witnesses have replied
no.
In that case, if you would please rise and raise your right
hand, I will swear you in.
[Witnesses Sworn.]
You may be seated.
All the witnesses responded affirmatively. And you are now
under oath and subject to the penalties set forth in Title 18
Section 1001 of United States Code. And you may now give a 5-
minute summary of your written statement.
There should be a light system that will tell you when that
time is come, so you'll have 5 minutes. It should go yellow at
1 minute, at red when your time is up.
And I will now start with Mr. Ventrell. You may begin. Make
sure your mic is up close and you turn your button on when you
testify.
TESTIMONY OF MARVIN VENTRELL, EXECUTIVE DIRECTOR, NATIONAL
ASSOCIATION OF ADDICTION TREATMENT PROVIDERS; MARK MISHEK,
PRESIDENT AND CEO, HAZELDEN BETTY FORD FOUNDATION; MICHAEL
CARTWRIGHT, CHAIRMAN AND CEO, AMERICAN ADDICTION CENTERS;
ROBERT NIZNIK, CEO, ADDICTION RECOVERY NOW AND NIZNIK
BEHAVIORAL HEALTH; JASON BRIAN, FOUNDER, REDWOOD RECOVERY
SOLUTIONS AND TREATMENTCALLS.COM; AND DR. KENNETH STOLLER,
DIRECTOR, JOHNS HOPKINS HOSPITAL BROADWAY CENTER FOR ADDICTION
TESTIMONY OF MARVIN VENTRELL
Mr. Ventrell. Thank you, Chairman Harper. Thank you,
Ranking Member DeGette. I also recognize the comments of
Ranking Member Pallone and the comments made by the committee
at large chair, Mr. Walden.
Thank you for the opportunity to be here today to present
this testimony. I represent the National Association of
Addiction Treatment Providers. I am the Executive Director of
the National Association, also known from time to time as
NAATP. Our folks will say NAATP. That all refers to us.
It is an honor to be here. I'm excited to give this
testimony because our association is fully supportive of the
work of this subcommittee. This has in fact been the focus of
the National Association for the past several years.
We are horrified by the behaviors that have occurred in
this field. They are not us. It is not unusual for a trade
association such as ours to perhaps object or resist certain
regulation. We do not do so in this instance. In fact, we have
been at the forefront of asking for this sort of regulation for
some time. That is why, among other things, we developed our
new code of ethics and are in the process of writing a resource
guidebook for the ethical and proper operation of addiction
treatment centers.
So thank you again for this opportunity. We wholeheartedly
support what you are doing. We want to be part of that. We want
to provide as much information as we possibly can for you. And
I look forward to giving this testimony today and answering
your questions.
Ranking Member DeGette specifically asked in her opening
comments for recommendations for choosing treatment centers and
for red flags in understanding what is not an appropriate
center. We have worked diligently on these very things. Much of
that resource is attached to my written testimony as a
supplement, and it should be ultimately in the record. And I
look forward, again, to articulating any of those principles.
Our association is grateful for this opportunity. On behalf
of our members and the thousands of patients that they serve,
and we support this committee's efforts to clean up the
practices that are harming us all.
This matter, ethical operation, professional operation, and
legal operation of addiction treatment is at the forefront of
our work. What has happened in our industry is among the
greatest threats to the success of our work as an addiction
treatment field that we have ever seen.
Historically, the practice of addiction treatment has been
marginalized. It has been stigmatized. And we have functioned
on the outskirts of healthcare. We are poised to make a change
in this regard now. We are poised with all of the developments
that have occurred in terms of science, social science, and
opportunity for funding and treatment. We are poised to do the
best work we have ever been able to do. That is what we wish to
do, and we are being delayed, and we are being impeded from
that by bad actors.
These bad actors that are the source of comments that the
committee made are a minority. They are a small minority, but
they are an effective and very damaging minority. They are not
our members. I wish to say that they are not we.
The National Association of Addiction Treatment Providers
is comprised of approximately 850 treatment campuses around the
country. These are good centers doing good work. The source of
the problem is not the national association. It is not common,
as I indicated, for a trade association to resist regulation.
Once again, we do not, in fact, we are promulgating much of
that within our practices now.
The primary issues have been accurately identified. I
applaud the subcommittee's staff memorandum. It is accurate,
and I adopt all of it. The problems we are facing are primarily
these.
Patient brokering, billing and insurance abuses, credential
misrepresentation, predatory web practices and foremost, in
predatory web practices is the matter of deceptive, unbranded
or inadequately branded websites.
While a trade association is not typically in the business
of policing, we have undertaken that role as it concerns our
members, and we have adopted an initiative called of the
quality assurance initiative, which has 11 components.
I would like to explain all of them to you. Of course, I
don't have time do that, but hopefully, you will ask me
questions about those.
In each of these 11 initiatives, many of which are focused
specifically on deceptive advertising matters are addressed in
the quality assurance initiative which will be fully
articulated in the guidebook that will be published later this
year.
I see that my time is up, and I thank you for the
opportunity.
[The prepared statement of Mr. Ventrell follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Harper. Thank you, Mr. Ventrell.
The chair will now recognize Mr. Mishek for 5 minutes for
the purposes of his opening statement.
TESTIMONY OF MARK MISHEK
Mr. Mishek. Thank you, Chairman Harper, Ranking Member
DeGette, and members of the subcommittee for inviting me. It is
an honor.
I am grateful for your leadership in addressing the opioid
crisis and addiction, and for the opportunity to testify today
about business practices and quality standards in the addiction
treatment industry.
My name is Mark Mishek, and I am the President and CEO of
the Hazelden Betty Ford Foundation, a non-profit addiction
treatment provider with 17 sites in 9 States. We treat over
21,000 people annually and are also engaged in prevention,
education, publishing, research and advocacy related to the
disease of addiction.
On behalf of the millions of vulnerable people and families
suffering from substance use disorders, thank you again, for
your bipartisan look into patient brokering and related issues.
Growing market demand for addiction treatment, driven by
the opioid crisis and expanded insurance coverage has attracted
unprecedented investment and an influx of new providers all
operating in a field that is under-regulated and lacks
consistent quality standards. It is in this environment that
our industry has seen the rise of unprofessional, unethical,
and sometimes illegal practices such as deceptive marketing and
patient brokering--not to mention excessive consumer billing
and insurance fraud. In too many cases, people who need help
are instead being harmed.
Most in our field do great work. But to ensure ethical,
quality care for all who seek help for addiction, we believe it
is time to establish quality standards and a consistent,
enforceable regulatory framework for the addiction treatment
industry. The stakes--patient safety and public confidence in
addiction treatment--are high.
Now, patient referrals, of course, are not bad, per se. The
problem is when referrals are made with little or no regard to
what is clinically appropriate for the patient when there is a
lack of transparency in the process and especially when
financial kickbacks are involved. That's when referrals become
patient brokering. Many brokering schemes begin with deceptive
marketing.
Now, at Hazelden Betty Ford, all of our treatment marketing
leads to one website, one consumer website,
HazeldenBettyFord.org. That is not the case for others who use
multiple sites and multiple brands to acquire patients.
Often, it is not clear who is behind ads for addiction
treatment or who consumers will get when they reach out for
help. Some providers obscure their affiliations to other
organizations or misrepresent the services they provide, the
conditions they treat, the credentials of their staff, or the
insurance that they actually accept. And some use online bait-
and-switch techniques to get calls from people intending to
call a different treatment center. Something, unfortunately, we
see frequently with our name.
All of this can lead to bad treatment for consumers. The
lack of transparency on top of minimal quality standards in the
industry puts patients at risk. These kinds of practices
certainly would not be tolerated in any other area of
healthcare. And in light of them and because of the life saving
work that we do, it is more imperative than ever for the
addiction treatment field to hold itself to the highest
ethical, legal, and quality standards.
Ultimately, we think reforms are needed to bolster State
licensure requirements, accreditation standards, clinician
education qualifications and access to comprehensive evidence-
based care.
Beyond State initiatives, Federal oversight through the
Federal Trade Commission, for example, is essential. Fraudulent
advertising and patient brokering obviously cross State lines.
Finally, we think a Federal law explicitly outlawing patient
brokering is critical.
Without such accountability, our field will continue to
evolve into a sector where success is predicated not on whether
patients get well or families heal, but on the size of your
advertising budget, your website analytics, your search engine
optimization, and your call center tactics.
Now is the time to restore faith and accountability in the
addiction treatment field, and it's time to establish quality
standards in that enforceable regulatory framework.
Thank you for the opportunity to share my testimony. And I
look forward to answering your questions.
[The prepared statement of Mr. Mishek follows:]
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Mr. Harper. Thank you, Mr. Mishek. The chair will now
recognize Mr. Cartwright for 5 minutes for the purposes of his
opening statement.
TESTIMONY OF MICHAEL CARTWRIGHT
Mr. Cartwright. Thank you, Chairman Harper and Ranking
Member DeGette. Thank you for having me here.
My name is Michael Cartwright I'm the Chairman and CEO of
American Addiction Centers.
Thank you Chairman Harper and Ranking Member DeGette. Thank
you for having me here.
My name is Michael Cartwright I'm the Chairman and CEO of
American Addiction Centers. We operate in 9 States. We offer 39
treatment centers.
I've been a treatment counselor and executive for 23 years.
For 12 of those years, I operated a not-for-profit
organization. I've also run both publicly traded, as well as
privately funded drug and alcohol treatment centers. I have
actually advised the U.S. Senate Health Subcommittee on
Substance Abuse and Mental Health Services back in the early
2000s when we were looking at co-occurring disorders in this
country and how we could better implement that.
I also serve on the board of directors of the National
Association for Behavorial Healthcare, which for 85 years has
advocated nationally for mental healthcare and substance abuse.
Its members include American Addiction Centers and other
publicly traded healthcare companies like HCA and Acadia UHS,
among others.
I've been in recovery for 26 years. As a young man, I
struggled with addiction. I know the pain of untreated
addiction. AACs mission is to help with those who are
struggling like I did, find the right treatment for psychiatric
and community support. I'm glad that Congress is looking into
treatment marketing practices. Treatment providers and
government officials should work together not just to keep bad
actors out, but to let potential patients and their loved ones
know who they can trust.
I'm glad that Congress is continuing to look at marketing
practices and treatment providers and government officials.
AAC's recovery brands business operates online treatment
directories, including Recovery.org and Rehabs.com. These
directories provide information about treatment centers across
the country. Centers that are also approved and listed by the
Federal Government Substance Abuse and Mental Health Services
Administration on SAMHSA.gov.
In fact, about 300 treatment providers, who are members of
the National Association of Addiction Treatment Providers or
NAATP, Marvin's association, either list or advertise on our
websites. A lot of treatment centers don't have large online
presences in their own right. Addicts who need help reach these
treatment centers through our website.
We don't engage in unethical market practicing like
hijacking phone numbers. We are not a call center aggregator.
We don't take calls for other treatment centers, just for our
own. We don't sell information gathered on calls, AAC opposes
this kind of lead generation.
We make sure that our website visitors know who they are
contacting. Under our transparency guidelines, we work with
treatment centers across the country to make sure their
listings are up-to-date and accurate. We make clear that users
know which treatment centers are going to answer the numbers
they call. We make clear that AAC's toll-free numbers go to
AAC's call center. And when they pick up, AAC's call center
reps identify themselves as an AAC employee.
Not all treatment centers market honestly, but they should.
AAC supports legislation that criminalizes fraudulent
advertising, outlaws tactics like hijacking of treatment center
phone numbers, requires disclosures about who owns and operates
call centers, and bans kickbacks and bribes. AAC has supported
this kind of legislation in its home State of Tennessee and
elsewhere.
I have the following recommendations. Congress should ask
the National Association of Insurance Commissioners or the
National Alliance For Model Drug Laws to draft a model law
banning deceptive marketing. Number two, existing or proposed
laws in Tennessee, Florida, and California should be considered
as models for reform. Number three, SAMHSA should update its
treatment center locator regularly, and should include sober
homes in its listings. SAMHSA should prioritize sober homes
that are members of the National Association of Recovery
Residences. Number four, existing FTC Truth in Advertising
Guidelines should be used to stop misleading addiction
treatment marketing.
While there is rightfully a lot of attention being paid to
bad marketing practices, I hope we don't lose sight of all the
great work that treatment centers do. Treatment does work. I've
been clean and sober now for 26 years. And throughout this
country we have great treatment centers, just like Hazelden
Betty Ford.
We need help. We have tens of thousands, almost 100,000
people a year dying from this disease.
We definitely need to look into this as a matter of a
marketing practice, but we also need to be looking at what are
some of the solutions to solve this epidemic.
Thank you very much for having me here today.
[The prepared statement of Mr. Cartwright follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Harper. Thank you, Mr. Cartwright.
The chair will now recognize Mr. Niznik for 5 minutes for
his opening statement.
TESTIMONY OF ROBERT NIZNIK
Mr. Niznik. Chairman Harper, Ranking Member DeGette, and
members of the subcommittee.
Thank you for the opportunity to share my perspective as
you continue your important investigation into various aspects
of the opioid crisis confronting our country.
Our focus at Niznik Behavorial Health is in offering
quality treatment to those seeking help at a time when such
services are most in demand and when there's a shortage of
available providers.
We help kids, mothers, fathers, individuals from a variety
of walks of life as they seek to take control of their lives,
overcome their battles with addiction, and return to their
families. We've helped thousands of individuals through our
inpatient and outpatient services at facilities we operate in
Texas, Florida, and in California, several of which fill a need
in underserved markets. In Texas, for example, our inpatient
facilities in our rural county is served by only one other
provider. We will soon be opening an additional facility in New
Jersey which will also help individuals in an underserved
market.
At the outset, I want to emphasize that neither NBH nor ARN
has ever operated as a patient broker, nor have we made any
payments to any intermediary or third parties for referrals. We
have not engaged in any of the activities that would appear to
be of concern to your and your colleagues as expressed in the
committee's May 29th letter. NBH is in the business of treating
patients. All of our NBH programs are licensed, in good
standing, and are accredited by the Joint Commission.
Our staff include board-certified psychiatrists, licensed
masters and doctorate-level clinicians as well as a
comprehensive nursing team. We offer a variety of specialized
programs, including an adolescent program.
I am very proud of what we have accomplished in only 5
years. We started with one facility in Miami, and upon being
licensed by the State of Florida, that facility began answering
calls from individuals seeking its services. As we added other
facilities, the customer service function relating to all
facilities was assumed by NBH. We now employ over 500
individuals and support hundreds of additional jobs. In fact,
I'm proud to say that we've given jobs to people in recovery.
Based on our experience, I would be pleased to share with
you how we market and advertise our services with full
transparency. Like you, we want to make sure that prospective
patients and their families are as well-equipped as possible
when they're seeking treatment for a loved one or for
themselves.
Choosing a healthcare provider is an important decision. We
believe it is essential that prospective patients know who a
provider is and that it described with full transparency what
services it offers, where it makes them available so that
prospective patients can make an informed decision.
When one of our customer service representatives receives a
call, the individual answering the call immediately identifies
himself or herself as an NBH employee. That way, all callers
know at all times that they are speaking directly with NBH.
If a caller seeks admission to an NBH facility, trained and
licensed medical and clinical personnel determine the medical
necessity and the clinical appropriateness of the services to
offer that individual.
The work of an NBH customer service representative is akin
to a receptionist in a doctor's office. A person who answers a
call, provides information regarding the service that the
doctor offers, and then schedules an appointment for the doctor
if a patient requests help.
We believe there are several factors that a patient should
consider when looking to identify a quality provider such as
whether they are accredited. They also want to know what
programs, therapies, and specialty that provider offers. They
will then be in a position to determine whether a provider can
help them or a loved one.
We're in the business of helping people and are only able
to succeed as a company when we provide quality and effective
care. Our patients consistently report that they are
overwhelmingly pleased with the quality of care and the
services they have received.
We have helped thousands of individuals get control of
their lives. And as part of our goal of helping people in need,
we have provided 296 full scholarships. With a full
scholarship, the patient's entire stay through all levels of
care and services is free.
In closing, I want to emphasize that we appreciate this
opportunity to put in perspective how we operate our business,
how our license and medical and clinical personnel help people
in need and how we believe individuals seeking treatment can
identify a quality provider.
Thank you again for the opportunity to make this opening
statement. I will be glad to answer your questions.
[The prepared statement of Mr. Niznik follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Harper. Thank you, Mr. Niznik.
The chair will now recognize Mr. Brian for 5 minutes for
his opening.
TESTIMONY OF JASON BRIAN
Mr. Brian. Thank you. My name is Jason Brian, and I founded
Redwood Recovery Solutions, the organization that owns
TreatmentCalls.com. It is my pleasure to be here today to share
with this committee my perspective on marketing and treatment.
My background prior to this industry is in insurance and
automotive marketing. Although we were successful in those
areas, my team and I shared the vision of wanting to make a
difference. And so Redwood started by quoting projects where
this was a strong purpose motivator not just a profit
motivator.
Redwood's model was at its core simply an advertising and
marketing firm that worked closely with many different types of
media companies that operated in TV, radio, search engine
advertising, and other marketing channels to generate inbound
phone calls from persons seeking substance abuse help and then
get them connected with a licensed treatment center. Redwood
did not own these sources or the agencies that ultimately built
or controlled the distribution of the media companies'
advertisements. Due to this, Redwood developed a strict set of
marketing standards and requirements for these agencies to
follow in order to work with us as an affiliate. These rules
forbid the use of any sort of incentive to the caller for
making the call. The use of any treatment centers intellectual
property, any attempt at intentionally deceiving the caller, or
any provision of any clinical guidance, just to name a few.
These affiliates were compensated a flat pre-negotiated
rate per call to Redwood. And at no time was their fee
structure contingent on the outcome of any call or the
placement of any patient. After receiving a call from an
affiliate, Redwood would then route this inbound phone call
directly to a licensed treatment provider within its network.
Redwood did not answer any of these inbound phone calls, but
rather, the licensed treatment providers were responsible to
answer the calls. It was in the sole discretion and
professional judgment of the licensed treatment program
answering the inbound call along with the caller themselves, to
make any decision about the appropriateness or lack thereof, of
a program best suited for the caller or their loved one. If a
referral was needed to another facility or level of care, it
would have been done solely by the licensed treatment provider
as Redwood made no referrals whatsoever.
I need to add clarity surrounding my past tense use of
Redwood, and share my brief opinion on the unfortunate reality
of painting with broad strokes. In January of this year,
collectively with my team, Redwood decided it was time to move
on from this industry. Far too often this industry and those
watching it from the sidelines, want to typecast marketing
companies as bad and unethical because of the abuse of a few
immoral, disgusting individuals. I would liken this to saying
that all treatment centers are bad simply because a few have
given the industry a black eye. That would be wrong and
misleading and unfortunate to those that they could have
ultimately served. Inevitably, when I discussed this topic
within the industry, people want to use a crisis moment and
vulnerability as a supporting argument for why companies like
mine are bad or unethical.
This past week, a good friend of mine lost her husband to
an overdose. He went to the best treatment money could buy, she
said. We all prayed this day would not happen, but his family
and I knew that this day might come. And indeed, our worst
nightmare came true.
The reality is that people seeking treatment do so for some
time. They search for months and even years in some instances
for a solution. This disease often gets worse over years or
even decades. I am in no way downplaying the seriousness of, or
the importance of, making the phone call, but to suggest that
the calls received are random impromptu decisions caught in a
moment of vulnerability is simply inaccurate.
The second point that always comes up pertains to the
appropriateness of a facility that the call is routed to. If
you find yourself asking how do you know if a generic help line
call was a good fit for a specific center, consider this. If
you search for treatment online and called any treatment center
that came up directly, would you finding them online qualify
that center to be the best fit for you or your loved one? If
you used a phone book and called one listed there, would that
be a perfect fit? If a center placed an advertisement on
television directly, might that do the trick in finding the
right one?
Of course, none of these things independently change
anything about the quality of care or experience one might
receive at any given center. Don't lose sight that these
treatment providers are licensed to do the work that they are
doing. And outside of gross negligence, these centers who share
the same licensure, even internally, still disagree largely on
what type of treatment is best for the same client. And
ultimately, that subjectivity is largely part of the
disparagement on where a call would be best suited. We've never
entered that conversation and have always taken the stance that
their licensure was good enough for us to work with them.
Placing a scarlet letter on marketing companies like so
many have doesn't change how treatment centers will handle the
phone call. And in fact, at least in our case, actually chases
away good people and good corporations that want to do good
work helping people.
Over 519,000 individuals place calls that were routed
through my company to facilities licensed to provide them with
help. Regardless of anything anyone may claim, lives have been
changed and saved because Redwood cared enough to do something
that made a difference. And I'm proud of that.
I would strongly urge anyone in this industry and those who
are tasked with creating legislation in it, to reconsider how
they look at marketing companies.
Quickly summarized, without them less money will be spent
connecting people with the help that they desperately need, and
even if all the marketing companies were gone, there wouldn't
be any fewer people in need of help and the bad centers would
still exist.
I'm happy to be part of this conversation and continue any
dialogue that helps accomplish the initial goal Redwood set out
on of helping people.
[The prepared statement of Mr. Brian follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Harper. Thank you, Mr. Brian. The chair will now
recognize Dr.Stoller for his testimony.
TESTIMONY OF DR. KENNETH STOLLER
Dr. Stoller. Chairman Harper, Ranking Member DeGette, and
members of the subcommittee, thank you for giving me the
opportunity to speak with you today.
With 64,000 overdose fatalities in 2016, we are fortunate
to have at our disposal effective evidence-based approaches to
treating substance use disorders.
In my experience, the impact of treatment is optimized when
three sequential actions are taken. Number one, using
opportunistic times and settings to engage potential patients.
Number two, completing a comprehensive initial assessment to
determine the best setting and type of treatment for each
individual. And number three, offering treatments that are
evidence-based, high quality, and dynamically adjusted.
Regarding action number one, I focus on referrals from
locations where people are most in need of treatment. Accepting
patients who have already been engaged in the healthcare system
prevents lost opportunities for lifesaving treatment. Hospital
emergency rooms and inpatient units have patients who survived
overdoses, are being treated for medical problems, resulting
from injection drug use, or are contemplating suicide. Other
referrals come from medical offices, other treatment programs,
and, of course, community walk-ins. By focusing on these
sources of referral, we serve patients who are most in need and
who otherwise would incur tremendous costs to the healthcare
system as high utilizers of costly services.
Regarding action number two, a comprehensive assessment is
done by my clinical staff as each patient is unique in terms of
their disorder, as well as their personal strength,
liabilities, and resources. Past treatment experiences can also
inform what to try next. For example, for those who have
repeatedly failed limited time episodes without medications, I
may recommend a medication trial in a setting of long-term
outpatient counseling and those who have severe mental health
and social problems might best succeed in a comprehensive
program with resources to effectively address all of those
problems.
Regarding action number three, the actual treatment, I
consider there to be five critical approaches that providers of
high quality treatment aspire to offer. Number one, they use
medications as clinically appropriate, including the three FDA
approved medications for opioid use disorder and three for
alcohol use disorder. They should be started, stopped, and
switched over time according to ongoing response. Number two,
they combine it with psychosocial treatments, including
counseling delivered by skilled professionals. Number three,
they use behavorial therapies that motivate positive change and
increase treatment adherence. Number four, they use adaptive
step care models. This means they use ongoing measurement of
outcomes to continually adjust the intensity and types of
treatment and to motivate engagement. And number five, they
incorporate wraparound services provided within the program or
through linkages with outside agencies to support a holistic
approach to recovery. This can include, medical, mental health,
housing, vocational, 12-step, and certified peer support
services.
Solid linkages to aftercare must be facilitated at the time
of discharge to ensure continuation of the recovery process.
As an illustration of some of these points, Mr. A was a 55-
year old man referred after a hospital detox admission to us
for alcohol and heroin use. He had HIV, hepatitis, and a
multitude of other medical problems. We began him on
buprenorphine and later switched him to methadone. We provided
him with counseling and housing when needed, and coordinated
with his local medical providers.
One day I received an inquiry from his managed care
organization after they determined that over the prior 17
months, he had 81 ER visits incurring tremendous cost.
On further examination, I discovered that only 4 of the 81
visits were during his time with us. The reduction in cost for
ER visits was ten-fold from a monthly average of over $3,000 to
$325 when he was with us, illustrating that fiscal gains can
result from comprehensive addiction treatment.
In conclusion, we are fortunate to have the ability to meet
these challenges head on with effective treatments for the
opioid epidemic. Comprehensive opioid treatment programs are
well-positioned to be hubs of expertise and coordination and
can be scaled up nationally to narrow the gap between
treatment, need, and availability.
I applaud your recent work in Congress to both increase
access and quality of substance use disorder treatment.
Thank you.
[The prepared statement of Dr. Stoller follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Harper. Thank you, Dr.Stoller.
It is now time for the members to each ask questions of you
as witnesses. And I'll begin by recognizing myself for 5
minutes.
As part of its investigation, the committee has learned
about a variety of advertising and marketing business models
within the treatment industry, including the use of websites
and phone numbers. There is a wide variation within the
industry. For example, Hazelden Betty Ford Foundation has three
websites that advertise its hotline.
Niznik Behavorial Health has ten websites. American
Addiction Centers has 13 facility-specific websites, and in
addition, has a subsidiary Recovery brands who operates a
portfolio of websites.
And Jason Brian of Redwood Recovery, TreatmentCalls.com has
84 domains, most of which appear to be related to substance use
disorder treatment.
So my question is, and I'll start with you, Mr. Mishek, but
also Mr. Cartwright, Niznik, and Brian, do each of your
websites contain information that discloses which company or
which facilities the websites are affiliated with?
Mr. Mishek. Our main website, HazeldenBettyFord.org, most
of our web hits come to that website. The other two that you
referenced are prior to our merger with the Betty Ford Center.
The Hazelden.org is about our publishing, and the other
website relates to philanthropy. So for consumers seeking
treatment, they go to one website, HazeldenBettyFord.org.
Mr. Harper. And have those disclosures always been on your
website?
Mr. Mishek. Absolutely.
Mr. Harper. OK. Mr. Cartwright.
Mr. Cartwright. Thank you, Mr. Chairman.
Yes, we have a variety of websites that specifically to
American Addiction Centers or our drug and alcohol treatment
centers in the different States, Desert Hope, Green House and
Texas, we have a treatment center. And then we have Recovery
Brands, which is the portfolio that you are concerned about.
Mr. Harper. OK. My question is, to be sure that I'm clear
here, do those disclose which company or which facilities those
websites are affiliated with at that point?
Mr. Cartwright. Yes, sir, they do.
Mr. Harper. OK. And have those disclosures always been on
those websites? And if not, when were they added?
Mr. Cartwright. They were not. We had bought Recovery
Brands. It was a company that was out of the State of
California. And when we bought that company, one of the things
that we do as a publicly traded company, we have a group of
lawyers that vetted those sites, went through them, looked at
those websites, looked at where we should be, make sure we're
in compliance. And we've done that over about a 2-year period.
Mr. Harper. Were they----
Mr. Cartwright. Go ahead.
Mr. Harper. Were they operational while they were being
reviewed and looked at by your team?
Mr. Cartwright. They were. They were owned by another
company. We had a group of attorneys that reviewed them, looked
over the websites, and we found that they were the most
ethical, straightforward websites that we saw as related to
third-party websites that we could find out there.
We asked them to do some changes, which they did, and
before we bought that organization. When we bought that
organization and since we've operated, it has absolutely been
100 transparent websites.
Mr. Harper. Mr. Niznik.
Mr. Niznik. Of the websites you mentioned, the majority of
them are facility websites. And when you go on the website you
know that it is the facility you're calling, or the NBH
websites, so you know who you're reaching. And then of the
other two websites we operate that are now branded as our
programs, they do disclose who owns them, who answers the
calls, and then when someone does call, the employee answering
the call identifies themselves as an employee of the company.
Mr. Harper. Have those disclosures always been on those
websites?
Mr. Niznik. They have.
Mr. Harper. From the beginning?
Mr. Niznik. They have.
Mr. Harper. OK. Then Mr. Brian?
Mr. Brian. Thank you. You referenced that we own 84
websites.
The question that was directed to me prior to this in the
phone call that I had was to provide a list of any domains that
I owned. Those 84 domains, I own. The company owns.
None of which are geared towards addiction treatment
outside of TreatmentCalls.com and Redwood Recovery Solutions.
Mr. Harper. OK.
Mr. Brian. And so those two sites are business-to-business
sites. So we don't have any sites. We've never owned sites that
induced a call from a treatment-seeking individual to a
treatment center. That wouldn't be our model.
Mr. Harper. OK. So those other 82 domains?
Mr. Brian. Yes, sir.
Mr. Harper. Are not related to addiction or recovery?
Mr. Brian. They were domains that were purchased. They
probably, most of which don't even have any content on them.
They were just websites that were listed that we purchased from
an online domain buying service.
Mr. Harper. Are they operational today?
Mr. Brian. No, sir.
Mr. Harper. Not operational?
Mr. Brian. I would imagine that less than a dozen of those
are operational, which are business-to-business like
TreatmentCalls.com is.
Mr. Harper. All right. And those dozen or so, they are set
up to, if you contact them, where does it go?
Mr. Brian. It would ring directly into TreatmentCalls, to
Redwood Recovery Solution, to our organization. There's no
business-to-consumer or consumer-facing sites designed to have
somebody call in for addiction help.
Mr. Harper. Does that domain, does it show on its face that
it's affiliated with Redwood?
Mr. Brian. Yes, sir.
Mr. Harper. All of those?
Mr. Brian. To other businesses, to treatment centers
seeking our service? Yes, it would say that.
Mr. Harper. All right. And my time is expired. So I will
now recognize the ranking member of the subcommittee, Ms.
DeGette for 5 minutes.
Ms. DeGette. Thank you very much, Mr. Chairman. Mr.
Chairman, I have here in my hand a list of Mr. Brian's websites
that you were referring to. I would ask unanimous consent to
put it in the record.
Mr. Harper. Without objection.
[The information appears at the conclusion of the hearing.]
Ms. DeGette. So Mr. Brian, I'm looking at all this list of
websites. I'm trying to figure out exactly how your business
worked.
Mr. Brian. Yes, ma'am.
Ms. DeGette. So what would happen is somebody--here's one,
TreatmentCalls.com. Somebody might go on to that website and
see a phone number and call, and that would go into your call
center. And then you would, your business would refer that off
to a certified treatment center, is that correct?
Mr. Brian. No, ma'am. And I can----
Ms. DeGette. OK. Tell me what happened, please, briefly.
Mr. Brian. Yes, ma'am. So TreatmentCalls.com is a site that
offers treatment call services to treatment centers. It's not a
site designed for consumers who might be looking for help.
Ms. DeGette. I see. So the way your business works though--
--
Mr. Brian. Yes, ma'am.
Ms. DeGette [continuing]. Is treatment centers would pay
you to refer calls to them. So there would be advertising,
people would call in----
Mr. Brian. Yes, ma'am.
Ms. DeGette [continuing]. To your phone numbers, and then
they would be referred out, right?
So there was no judgment on the part of your business about
which centers would be appropriate to send the calls to. The
calls would be referred to the centers based on who, which
centers paid you money to refer the calls to them, right?
Mr. Brian. If I can just correct one portion of it.
Ms. DeGette. Please.
Mr. Brian. We did not own the phone numbers or the
websites. We worked with third-party affiliates that we----
Ms. DeGette. OK.
Mr. Brian [continuing]. Made a per call fee.
Ms. DeGette. Right.
Mr. Brian. We paid them.
Ms. DeGette. Right.
Mr. Brian. And the treatment centers ultimately paid us a
per call fee for sending them calls.
Ms. DeGette. So people called the phone number.
Mr. Brian. Yes, ma'am.
Ms. DeGette. And then that went somewhere else.
Now, Dr.Stoller, has your organization ever used a system
like this to get patients for your facility?
Dr. Stoller. Well, fortunately or unfortunately, the
prevalence of substance use disorders----
Ms. DeGette. Yes or no will work.
Dr. Stoller. No.
Ms. DeGette. Have you ever used a substance like this, and
why not?
Dr. Stoller. No, we haven't.
Ms. DeGette. Why not.
Dr. Stoller. We don't need to do that sort of outreach for
patients.
Ms. DeGette. Do you think that's an effective way for
patients to get matched with an appropriate treatment facility?
Dr. Stoller. We prefer to link with other providers who
have already engaged with patients.
Ms. DeGette. So, in other words, you think the best
practice, as you testified in your testimony, is when a doctor
or somebody else sees a patient or an emergency room refers
them to you. Is that right?
Dr. Stoller. I do.
Ms. DeGette. Now, Dr. Mishek, let me ask you that same
question. Does your organization use call centers like this
where people come in and are referred to you?
Mr. Mishek. Absolutely not.
Ms. DeGette. And why not?
Mr. Mishek. Well, we don't need to. Number one, we're
overwhelmed with calls directly into our call center. And
number two, we need to take the people who come to us and
assess them. We don't need a third party to be funneling
someone to us who may have an eating disorder and shouldn't be
coming to us in the first place.
Ms. DeGette. Well, this is an interesting question to me
because the two of you gentlemen are here representing two of
the premier centers in this country, but there are thousands of
people who need addiction services who might be going to other
centers. So do you think there's some kind of inherent problem
with using these call aggregators like we heard about from Mr.
Brian?
Mr. Mishek. I certainly do. Only 1 out of 10 people who
need help get help, so there are plenty of patients out there
who need help. It's not like there's a scarcity of patients and
we're all fighting over the next patient.
Ms. DeGette. Right.
Mr. Mishek. It's not that way at all.
Ms. DeGette. Right.
Mr. Mishek. So, treatment centers that are accredited, have
good, licensed staff, and are doing great work generally don't
have any trouble acquiring and attracting patients, both
through professional referrals, through word of mouth, and
through community reputation.
Ms. DeGette. Mr. Ventrell, you look like you want to add.
Mr. Ventrell. Well, I was nodding along, Congresswoman. The
issue becomes whether a clinical assessment is being made or--
--
Ms. DeGette. Right.
Mr. Ventrell [continuing]. A sales assessment is being
made----
Ms. DeGette. Right.
Mr. Ventrell [continuing]. And that's essentially the
distinction that's drawn here today by Dr. Stoller and Mr.
Mishek. People are looking for healthcare.
Ms. DeGette. Right.
Mr. Ventrell. The word ``rehab'' itself has caused us to go
down the wrong path, but people are looking at healthcare and
you look for healthcare at the hospital. You look for
healthcare at the facility that provides that healthcare. To
have a website that does not identify primarily as its owner,
the clinical provider is fundamentally deceptive, in our view.
Let me just also say quickly that the little ``I'' isn't
good enough. The little ``I'' isn't good enough. So one of the
questions that the chairman asked is, does your site identify
or disclose your identity?
Ms. DeGette. Yes.
Mr. Ventrell. That's a very thoughtful question, but I
don't think it should even have--that question shouldn't even
have to be asked.
Ms. DeGette. Right. They should know who they're calling.
Mr. Ventrell. It should simply be the site of the
individual.
Ms. DeGette. Right.
Mr. Ventrell. I don't go to the little ``I,'' and consumers
in crisis certainly don't know how to do that. And the fact
that it ultimately identifies it is, frankly, wholly
inadequate.
Ms. DeGette. Thank you very much. Thank you, gentlemen.
Mr. Harper. Ranking Member DeGette yields back.
The chair will now recognize the chairman of the full
committee, Chairman Walden, for 5 minutes.
Mr. Walden. Thank you very much, Mr. Chairman.
Again, thanks to everybody on the panel as we try and dig
into this issue and figure out how things are working, how
they're not working, and where there needs to be improvement.
So I guess one of the questions I'd have off the top is,
the business model for one of today's witnesses, Mr. Brian of
Redwood Recovery, appears to be entirely based on the sale of
prospective patient calls to treatment facilities. And my
question is, have your companies, your facilities, or your
subsidiaries ever paid or sold for leads? And I would address
that to Mr. Niznik, Mr. Cartwright, and Mr. Mishek.
Mr. Niznik. So we advertise in a lot of mediums online, on
television, on the radio. So the only sorts of advertising we
do is that sort, the traditional advertising where someone sees
an ad or comes across our website and calls us.
Mr. Walden. OK. So the question is, have your facilities or
your subsidiaries ever paid for or sold leads?
Mr. Niznik. No, we haven't.
Mr. Walden. OK. Next, Mr. Cartwright.
Mr. Cartwright. With Recovery Brands' websites, it's a
business model very similar to YP.com, yellowpages.com, or
WebMD. We have advertisers on those websites. Three hundred
advertisers are NAATP members. Actually, Betty Ford Center used
to be a pretty large advertiser of ours as well. So we have
advertisers on our websites, recoverybrands.com.
So thank you very much.
Mr. Walden. All right.
Mr. Mishek. No, we never have.
Mr. Walden. Never paid or sold leads?
Mr. Mishek. No, we never have.
Mr. Walden. OK. Mr. Ventrell, the National Association of
Addiction Treatment Providers recently updated its code of
ethics, with particular focus in the advertising and marketing
space, to fight back against practices of patient brokering,
including this kind of lead generation. Can you explain and
perhaps write a few examples for what practices the Association
was seeing in the substance use disorder treatment industry
that led it to revise its code of ethics? What did you see?
Mr. Ventrell. Yes, Mr. Chairman. Thank you. National
Association had a code of ethics for some time. In spirit, it
prohibited all the kinds of practices that have been discussed
here today. However, it wasn't thought necessary, prior to last
year, that we specifically articulate exactly what right and
wrong is. Our good providers didn't need to be told right and
wrong. They were just doing right. But we came to understand
that that's not true across the board, and we approved our new
ethics code 2.0 on December 31, 2017, and it became effective
on January 1. It specifically defines and prohibits the kinds
of conduct we're talking about today.
The first and foremost of these would be patient brokering.
Under no circumstances may an NAATP member or under any
circumstances should any treatment provider, in our view, buy
leads or sell leads. And so if there's a connection with doing
that, it is prohibited by our code and you may not be an NAATP
member.
A second area that came up frequently was licensing and
accreditation misrepresentation. It is difficult enough for the
consumer to understand what they need. When the provider
misrepresents or does not adequately display precisely what
they are licensed or accredited for, the consumer can't know
what they are getting, and that lack of regulation is extremely
dangerous.
The third and most prevalent reason why we removed certain
members from our rolls, Mr. Chairman, is what we call unbranded
or inadequately branded sites. You received information from
your staff that indicates, among other things, that we have
sacrificed approximately $100,000 in dues revenue and removed
24 parent companies from our membership rolls primarily for
this reason.
There are multiple reasons, but the primary reason why
members were not renewed, or as incoming applications occur and
are denied, is because we find that there is inadequate
branding on the site for the same reason that I just discussed
with Ranking Member DeGette: The ability to somehow investigate
and determine ultimately that the site is connected to a
provider is simply not adequate. It should be branded as, for
example, the Hazelden Betty Ford site is.
So for the most part, where we have removed members or not
invited members or declined an application it has been because
of the deceptive websites.
Mr. Walden. All right.
Mr. Ventrell. It's just a question of transparency, Mr.
Chairman.
Mr. Walden. Thank you. Thank you.
I want to go back, because I maybe didn't hear this right,
to Mr. Cartwright. I was looking at my notes here. Just yes or
no, have your companies, your facilities, or your subsidiaries
ever paid for or sold leads?
Mr. Cartwright. No, we don't pay for or sell leads.
Recovery Brands has an advertising model very similar to WebMD
or yellowpages.com, and I'm assuming that Hazelden Betty Ford
and NAATP must like that model, because about 300 of the NAATP
members are advertisers of ours. About half of our advertising
revenue comes from NAATP members, so we hold ourselves up as a
solid organization of the way you can do and should do
advertising on the internet.
Mr. Walden. I'm just sensing, Mr. Chairman, with your
indulgence, maybe a disagreement on the other end of the panel.
Is that accurate? Mr. Cartwright----
Mr. Ventrell. Mr. Chairman, are you recognizing me?
Mr. Walden. Yes.
Mr. Ventrell. Thank you. I--Mr. Cartwright's written
testimony, which I saw for the first time yesterday, indicated
this 300 number, that there are 300 NAATP members which
advertise on the site. I am unfamiliar with this. I'm surprised
to hear this information, but I am entirely open to finding out
exactly what it is.
I would ask for the opportunity to determine whether that's
true by being provided a list of those 300 members, and then
also ask ourselves what do we mean by advertising, right. There
is a common practice generally among the problems on the
website to bring in good providers, put them on the site.
I'm not saying this is the case here. I don't know that.
But there is a common practice to grab a Hazelden Betty Ford or
a Caron or a Harmony Foundation and put their information on
the site as if it were part of when, in fact, there is not a
motive to produce that----
Mr. Walden. Right, OK. Mr. Cartwright, are you OK sharing
that information with them so we can get to the bottom of this?
Mr. Cartwright. I would be happy to share it. And the
easiest way to look at it is, we generate about $8 million a
year of our $400 million annual budget through advertising. And
about one-half of that $4 million a year is coming from NAATP
members.
Mr. Walden. Thank you for your indulgence, Mr. Chairman.
Mr. Harper. Chairman Walden yields back.
So if you'll make sure, Mr. Cartwright, you get us that
list, that would be very helpful.
The chair will now recognize the gentlewoman from Florida,
Ms. Castor, for 5 minutes.
Ms. Castor. Thank you, Mr. Chairman and Ms. DeGette, for
calling this hearing.
There are all sorts of press reports out there about
unscrupulous actors that engage in deceptive marketing
practices and who take advantage of patients, and I've heard
directly from many families back home in Florida. And I'd like
to discuss some of the problems and what we can do to solve it.
Mr. Ventrell, you've gone into some detail here with--could
you further expand on what you see as major problems with
deceptive sales in the addiction treatment industry and how
they prevent patients from getting the care that they need?
Mr. Ventrell. Thank you, Congresswoman. If one begins by
assuming that we need a transparent clinical assessment, much
of the problem goes away. The fundamental problem is that most
of the problematic areas do not promote a clinical assessment
where the patient or the consumer understands who is performing
that assessment. It's compounded by the fact that folks don't
know what clinical assessment that they need.
The primary areas continue to be licensing and
accreditation confusion and misrepresentation, unbranded or
inadequately branded sites. And toward those goals, we have
been very clear in two ways: One, you must have that clearly
branded site, and now our association has, as of this month,
adopted a new requirement that all NAATP members must be
accredited.
There needs to be a system whereby quality and safety are
adequately regulated and business operations are adequately
regulated. The accrediting, certifying, licensing bodies
traditionally and appropriately handle quality and safety.
There has been very little regulatory oversight as it concerns
business operations, and that is why we are producing the
guidebook for operations, which I will hopefully commend to the
committee for study.
Ms. Castor. First of all, you have a family or an
individual that is searching for information on how to get
substance use treatment, you're not shopping for clothing or
something else.
And, Dr. Stoller, you highlight this problem too. Is it
appropriate to go shopping on the internet for how you're going
to be treated for addiction?
Dr. Stoller. I would recommend somebody looking for
treatment on the internet to go to particular sites, such as
the SAMHSA treatment locater. The National Institute on
Alcoholism and Alcohol Abuse has recently created a website
that helps consumers to look at those sorts of things.
The other thing is that jurisdictional entities, such as
county health departments, are really good sources for
information about substance use disorders and also where they--
that people might be able to go to achieve the best match for
the person's needs with the treatment program that can provide
them with those services.
Ms. Castor. Rather than shop in general on the internet and
see what comes up in the ranking on that page and then hit the
first one and----
Dr. Stoller. That's correct.
Ms. Castor. So, Mr. Ventrell, you said your organization
has removed members for failing to adhere to the code of
ethics. You went into some detail on that, on patient brokering
and buying and selling leads. Is it possible that conduct by
one of your former member organizations that violated the code
of ethics also violated the law?
Mr. Ventrell. It's possible, Congresswoman, but I don't
know specifically of an instance of that. Certainly, it is
possible.
Ms. Castor. Does that need to be clarified? What do you
understand the law to say?
Mr. Ventrell. Relative to what precisely?
Ms. Castor. To patient brokering.
Mr. Ventrell. Well, the law of patient brokering has been
very confusing and, to some extent, nonexistent and State-by-
State based. It needs to be clarified, and I would support Mr.
Mishek's recommendation that there be a Federal law in this
regard.
So we've all heard of the horrors that occurred in south
Florida. Certainly, there was similar activity in Arizona and
also southern California, and it's probably not isolated to
those States. If patient brokering, body brokering, paying for
the delivery of a body for care was made, one would have to
determine what the State regulation was and that would be a
legal determination.
I will say, however, that if Federal moneys were being
involved in the treatment of that individual, Medicare,
Medicaid, that I believe I would be correct in saying that that
would have been a legal violation, irrespective of State law.
Ms. Castor. Thank you very much. I yield back.
Mr. Harper. The gentlewoman yields back.
The chair will now recognize the vice chairman of the
subcommittee, Mr. Griffith, for 5 minutes.
Mr. Griffith. Thank you very much, Mr. Chairman.
I'm going to build on some of the prior testimony and
questions about NAATP's updated code of ethics.
Mr. Cartwright, as you've indicated to Chairman Walden,
there are about 300 treatment providers that are members of
NAATP who advertise on your website. So my question is, if I go
to your website later today, am I just going to find your
traditional straight advertising, treatment center A, treatment
center B, treatment center C, and it just rotates based on
who's up next like the line of cabs? Is that how your system
works?
Mr. Cartwright. No, sir, it doesn't. It operates very
similar to YP.com, yellowpages.com. If you go into a particular
area in the State of Colorado and you went into Denver, it
would only list operators within that State, and then there
would--I'm sorry.
Mr. Griffith. No, that's fine. I got it.
And so the question is, it helps focus where you're going,
is what you're saying. But my question is, is it just
advertising? Are you telling us that you don't get paid
anything for a straight referral or for a head count?
Mr. Cartwright. That is correct. It's straight advertising.
Mr. Griffith. And that's never been the case?
Mr. Cartwright. That's never been the case.
Mr. Griffith. And so when these ads are up there, your
folks don't actually talk to the people, and it just focuses
them in and--the next question is, what sort of vetting, if
any, does AAC do before letting another treatment provider
advertise on your website?
Mr. Cartwright. They would need to be on the samhsa.gov. We
really take that website very seriously, that we're assuming
the Substance Abuse and Mental Health Administration in their
listing is vetting folks. They have to be licensed, joint
commission accredited or CARF accredited.
Mr. Griffith. OK. Is AAC itself a member of the NAATP?
Mr. Cartwright. We're a member of a different organization,
National Association of Behavioral Healthcare. It's been around
for about 85 years. A lot of the larger companies join that.
You've got to remember, most of NAATP is smaller, not-for-
profit organizations. We feel like that with HCA and Acadia and
UHS, some of the larger organizations, that's meeting our needs
more appropriately.
Mr. Griffith. Prior to the new ethics standards that we've
talked about today, weren't you all a member of the NAATP?
Mr. Cartwright. I go back two decades being a member of
NAATP, back to when I was on their board of directors. So,
again, back when I was a not-for-profit agency, I thought that
was a very effective organization. I could go back and look at
the exact date that we're no longer members, but you're right,
Marv asked us not to be members based on their new marketing
practices or ethical guidelines that he has.
I really don't think he fully understood, though, our
websites. I think he got confused with some other websites that
are absolutely websites that are nontransparent. And we're
supportive of new marketing standards. In the State of
Tennessee we just passed the toughest law on marketing
standards, and we would recommend, just like Mr. Mishek did,
let's take that national. Let's do that on a national basis and
take a law like Tennessee or take a law like Florida--they've
been working very, very hard in the State of Florida to get
this right. We would support that. We actually were extreme
supporters of that measure that passed in the State of Florida,
California, and Tennessee. If you want to talk to some of the
legislators in those States about our activity, I'm happy to
put you in touch with them.
Mr. Griffith. Mr. Ventrell, you want to make any comment on
that?
Mr. Ventrell. I must be demonstrative in my demeanor that
suggests to the members of the committee to call on me when I
haven't raised my hand, but thank you.
Mr. Griffith. Was there merely a misunderstanding? That's
what I'm trying to find out. Did you not understand what he's
doing?
Mr. Ventrell. Mr. Cartwright just suggested that I might
not fully have understood what American Addiction Centers was
doing. What happened was at the expiration of American
Addiction Centers term, which was December 31 of 2017, we
reviewed its practices and determined that it wasn't in
sufficient compliance with our ethical rules. The primary
reason for that was the website issue, the inadequately branded
or unbranded website, so we did not invite them back.
Mr. Griffith. OK.
Mr. Ventrell. It's as simple as that.
Mr. Griffith. So the primary issue was that you couldn't
tell--if you just went there--you couldn't tell whether it was
one of theirs or somebody else's or what treatment center was
being referred and who was telling folks to do that. Is that
accurate?
Mr. Ventrell. Yes. We believed it was inadequately
transparent.
Mr. Griffith. All right. I've got to move on to some other
questions.
Mr. Cartwright, I'm going to switch gears on you. AAC
operates several websites that might appear to consumers--and
it gets to the same vein--but it might appear to consumers to
be unaffiliated third-party resources, such as drugabuse.com,
rehabs.com, projectknow.com.
Mr. Niznik, your company does the same thing through its
operation of addictionrecoverynow.net and
findingtreatmentnow.com. Unless consumers click on the
information buttons next to the 1-800 numbers advertised on the
website, isn't it true they may not realize who is behind the
websites or answering their calls?
First, Mr. Cartwright, yes or no. And then, Mr. Niznik,
isn't it true they may not realize who's behind the websites or
answering their calls?
Mr. Cartwright. I think it's very clear on our websites
that they know who they're calling.
Mr. Griffith. Mr. Niznik?
Mr. Niznik. I also believe it's pretty transparent on our
sites who they're calling, and then, more importantly, when
they do call, they immediately know who they're talking to. So
even if they've read a blog or content online, as soon as they
speak to someone, they know who they're dealing with.
Mr. Griffith. And I see I'm over my time. But Mr. Ventrell
earlier said pushing on the ``I'' doesn't work. I'm out of
time. I apologize.
I yield back.
Mr. Harper. The chair will now recognize Mr. Tonko for 5
minutes.
Mr. Tonko. Thank you, Mr. Chair. Thank you to our
witnesses.
When opioid addiction patients are seeking help, what
matters most is that they get the quality care that they need.
The problem is many families don't know what to look for in an
addiction treatment provider. And the promises that some
facilities make, such as expensive housing and various forms of
therapy, sound enticing, but families need to know what will
actually help their loved ones in their treatment.
So, Dr. Stoller, you run the addiction center at Johns
Hopkins, which has an excellent reputation for high-quality
treatment. And I understand you also provide all of the
medication-assisted treatment options such as buprenorphine and
methadone with that MAT concept. How do you determine whether a
patient should receive MAT and which MAT therapy is
appropriate?
Dr. Stoller. Thank you. We do a comprehensive evaluation
upon consideration of admission of any patient. At the end of
that comprehensive evaluation, we might recommend that the
person go someplace else. Maybe they need an inpatient
admission for alcohol detoxification or something else.
The most important thing is that the patient has particular
needs that we feel like we can match. The way that we match
that, let's just look at medication-assisted treatment, is that
we look at, number one, patient preference. So some people come
with a particular preference. Number two, we look at their past
history of treatment, both their successes and their failures.
Both are important in determining what the person might need
right now. We also look at other medications that they might be
on, their particular symptoms of disorder, how long they've
been using, and the severity of their use.
Mr. Tonko. Thank you.
And as we know, millions of Americans are affected by this
crisis, and not every family can afford the higher-end
facilities. Dr. Stoller, what treatment options are there for
people with limited means, and do you have to spend a lot of
money to get quality care?
Dr. Stoller. So I'll go back to my written and oral
presentation. I think that there are particular requirements of
a treatment program in terms of delivering care that is
comprehensive. The use of medication-assisted treatments for
people with opioid use disorder is very important, and if the
particular program doesn't deliver it themselves, for whatever
reason, then connections and very strong linkages with programs
and physicians who do is very important.
We have a hub-and-spoke model where we use our opioid
treatment program as a hub, and we work very closely with area
primary care providers and psychiatrists who might be providing
that medication-assisted treatment.
Mr. Tonko. Thank you. And what are some reliable metrics to
use to demonstrate a success rate for opioid addiction
treatment?
Dr. Stoller. One of the most important ones is retention
within the system of care at a level of care that matches the
person's need. So when somebody leaves treatment with us,
despite the fact that they need ongoing treatment and they're
leaving the treatment system, that's not an indication of
success. That said, if the person is leaving with a very
positive sense of hope of what a treatment program can offer
them and they come back to us, that could be good. We also----
Mr. Tonko. OK. I've got a few questions here to go, so I
want to get to everyone.
Mr. Mishek, Hazelden Betty Ford is another gold standard in
this industry. Your written testimony speaks to quality
standards you've identified for addiction treatment providers.
Briefly, how do you determine what a successful treatment is,
and how do you measure outcome for your patients?
Mr. Mishek. We measure outcomes by checking back with our
patients at 1 month, 3 months, 6 months, 9 months, and 1 year
after they leave our care, at whatever point they leave our
care, whether it's after an extensive long-term treatment or
after, let's say, 3 weeks of residential care. We measure three
things: continuous abstinence during that period of time;
second of all, we measure percent days abstinent. That is, they
may have relapsed during that period of time, but if they got
right back into the program with hope and move forward, that's
great, and we would consider that a success. And then finally,
we have a series of quality-of-life measures that we measure
over that period of time. So those are the metrics that we have
in place that we've had for a number of years.
Mr. Tonko. Thank you.
And, Mr. Cartwright, turning to you, I'll ask you about how
your facility ensures high-quality care. And first of all, in
your response to the committee's letter, you provided your
client outcome study that found ``63 percent of AAC patients
maintain abstinence 1 year after treatment.'' How many patient
responses is that 63 percent success rate based upon, and just
how many patients enter the doors of AAC treatment centers each
year?
Mr. Cartwright. Thank you very much. I'm most proud of the
outcome studies. We partnered with an organization in
Nashville, Centerstone Research Institute, to do a 3-year
longitudinal study. Many times you'll see SAMHSA do these
studies or NAADAC do these studies. We had 4,000 patients that
went through this study with Centerstone Research Institute.
They're the ones that conducted the followup calls, very
similar to Mr. Mishek. They did that on the intake process, 2
months, 6 months, and 1-year posttreatment. And we have an
entire study. We can get all the members of the committee that
study. Be happy to dig in and get you in touch with Centerstone
Research Institute that actually conducted the study.
Mr. Tonko. And how many are you saying completed that 1
year?
Mr. Cartwright. Four thousand. Four thousand people went
through the study, and I can get you the details on the entire
study. TCenterstone Research Institute is the one that did the
study. We didn't do that ourselves. We didn't have our staff
members calling the patients back. It was a research institute
that did that for us.
Mr. Tonko. So I'm clear on the response, so you said you
sent--you had--approached how many people to respond?
Mr. Cartwright. Four thousand.
Mr. Tonko. And how many responded that had that 63 percent
success rate? How many of those 4,000 responded?
Mr. Cartwright. Again, I can get you the exact numbers from
Centerstone Research Institute. They're the ones that conducted
the study. My staff didn't conduct the study, but I can get you
the details on that study if you'd like it.
Mr. Tonko. Thank you very much, Mr. Chair. I yield back.
Mr. Harper. The gentleman yields back.
Before I recognize the next member for questions, I just
want to be clear, Mr. Ventrell, you had stated earlier that the
little ``I'' isn't good enough. And I assume by that you're
referring to the little circle, the information button on a
website that you have to click on?
Mr. Ventrell. That's correct.
Mr. Harper. OK. With that, the chair will now recognize Dr.
Burgess for 5 minutes.
Mr. Burgess. Well, thank you, Mr. Chairman.
And, Dr. Stoller, thank you for your testimony, and thank
you for your honesty when you address the fact that it's
complicated. In the treatment of these patients, the disease
itself is complicated. The people who are affected by the
disease themselves can be sometimes very complex individuals
with very complex histories and, oftentimes, there are
confounding comorbidities that have to be taken into
consideration. And as a consequence--well, let me just back up
a little bit.
Your expertise that you bring to this, you are a board
certified psychiatrist? Is that correct?
Dr. Stoller. Yes, I am, and with additional qualifications
in addiction medicine.
Mr. Burgess. So the committee had the ability to refer
everyone with this problem to you or someone of similar
qualifications, but unfortunately, that's not always the case.
And we are left with trying to provide as much care as possible
to protect the greatest number of people, but recognize that
it's an imperfect process.
But at some point I would love to visit with you and get
your perspectives on how much is OK, how much is too much. And
I suspect you have some pretty keen insights into this, and I
really would welcome the opportunity to follow up with you on
your experience in treating, again, this very complex type of
patient.
Dr. Stoller. My pleasure.
Mr. Burgess. Mr. Ventrell, let me ask you a question.
And thank you for that answer.
Your organization, the National Association of Addiction
Treatment Providers, so you had some people that you did not
renew because they did not meet your standards. Is that
correct?
Mr. Ventrell. That's correct.
Mr. Burgess. And tell me again how many different centers
you did not renew?
Mr. Ventrell. Yes. First of all, let me explain that
sometimes we will hear a number that represents campuses, other
times you will hear a number that represents the parent
corporation.
The answer to your question is 24 parent corporations, 99
facilities. And that is the number, sir, as of last week,
Friday.
And so what has happened is the majority of NAATP
membership functions on a calendar year. The majority of
members expire on December 31 of the calendar year. So that is
why the vast majority of those who are no longer part of our
rolls were deleted at that time. But this continues to go on
throughout the year, and as we receive applications or see
other issues, we may remove based on that.
So the number has increased since December 31, which was
the number that that your committee staff gave you.
Mr. Burgess. So you're in the rehabilitation business or
you represent companies that are. Are there some of those
people who fell through that--some of those organizations or
those facilities that were just one or two clicks off of being
OK where you could work with them and bring them back into the
fold, or was it once you're done, you're done?
Mr. Ventrell. Thank you for that question, because our goal
is not to remove members. Our goal is to create a society, a
professional society of treatment providers that are aligned in
terms of values-based care and ethics. And so what we want to
do when we receive a complaint or become aware of an act is to
contact that treatment provider and say, this is a problem. Can
you fix it?
Mr. Burgess. Let me ask you about that, that becoming aware
of something. And I'm purposely not asking our other witnesses
about any history of lawsuit activity or pending litigation. I
don't want to get into that. But is that something that you
consider through NAATP, if there has been a settlement, if
there has been an action or an allegation, is that something
that you evaluate?
Mr. Ventrell. As it concerns potential liability to our
organization, is that your question?
Mr. Burgess. No. The liability experience of one of the
providers. Is that something that would be a red flag?
The reason I bring that up is I cited the testimony that we
had last December from Eric Gold, who was an assistant attorney
in the Massachusetts Attorney General's Office. And I asked him
the question, I said, look, I'm a doctor. I practiced for
years. If things are not going well, you worry about liability
lawsuits, and where are those liability lawsuits for the types
of organizations that he brought before our committee that
morning. And he said, well, it just doesn't happen. And that
was a little bit astounding to me. I've got to believe that
sometimes litigation does result.
Do you evaluate that litigation when that's all public
knowledge, correct?
Mr. Ventrell. Certainly. We want to know what all of our
centers are doing in terms of clinical and business operation,
and if we become aware of that, that would certainly be a red
flag that concerns us.
Mr. Burgess. And so has that happened?
Mr. Ventrell. Not specifically to my knowledge, no.
Mr. Burgess. Has not. And, again, I find that surprising.
I just have one last observation, and I want to ask our
treatment centers predominantly to get back to me with this
information. One of the family members that was interviewed in
our roundtable earlier this year talked about her son. She said
it was continued on her medical insurance up to age 26,
eventually died of an overdose, but not before he had been
resuscitated seven times with Narcan in emergency rooms.
And her question to us was, how can he still be on my
insurance and I not be informed of this type of activity, and
what was preventing someone from telling me that my son was in
an emergency room seven times requiring Narcan? So, again, I'm
going to submit that question for the record, but I would be
interested in your responses to that.
And I yield back, Mr. Chairman.
Mr. Harper. The gentleman yields back.
The chair will now recognize the gentlewoman from Indiana,
Chairman of our Ethics Committee, Mrs. Brooks, for 5 minutes.
Mrs. Brooks. Thank you, Mr. Chairman.
And I would like to talk a little bit about the call center
employees and concerned about the types of incentives that
might happen relative to call centers and connecting. Although
I certainly appreciate that, as we've talked and heard, those
with addictions that I've talked to or their families, I
appreciate that it is incredibly difficult work that treatment
centers provide. And success rates are very difficult. Relapses
are common. Dropping out of centers is common. This is an
incredibly difficult group of people to work with.
Unfortunately, it's large and growing, and we've got to
make sure, in our oversight role, that we are providing and
making sure that these folks are not being taken advantage of.
And addicts that I have talked to, by the time they get to
the point where they're ready for treatment, they are that
desperate or their families are that desperate and have usually
tried many centers. The last center I visited, one young man
said it was about his third or fourth center he had been in.
And so I think that this is a really difficult problem
we're trying to work on, and that's why we want to make sure,
whether they go to the internet, whether they're going to a
phone book--I don't even know that anybody is using that
anymore--but whatever they're doing, we want to connect them
with the best treatment possible.
And with all due respect, no one knows what SAMHSA is. An
addict doesn't. I would say, we as government and providers do,
but we have got to get this figured out. And there also aren't
nearly enough psychiatrists coming out of our med school
classes and addiction specialists. And so we've got to keep
focused on this problem because we are losing far too many
people.
I'd like to know, maybe Mr. Cartwright, Mr. Mishek, and Mr.
Niznik, how are your call center employees paid, and are they
given bonuses?
Mr. Cartwright?
Mr. Cartwright. Yes. Thank you very much. And I appreciate
your comments. You're so right in terms of the devastation of
this disease in keeping it on treatment and quality of care.
I'm in a unique position because I----
Mrs. Brooks. And I'm sorry, I have several questions. And I
appreciate that, comments on my comments. But how are your call
center employees paid and what fact--and are they given bonuses
and what determines whether or not they receive a bonus?
First, how are they paid, Mr. Cartwright?
Mr. Cartwright. Today they're paid a salary.
Mrs. Brooks. OK. A salary. No bonuses?
Mr. Cartwright. Today it's a salary. Prior to July 1--and
again, I go back to the Tennessee State law that was passed. I
think it's the most aggressive law in the State related to
these bad practices that we all want rid of. They were paid on
a commission basis.
Mrs. Brooks. And you've changed that?
Mr. Cartwright. Yes, ma'am.
Mrs. Brooks. Mr. Niznik, how about you, how are your call
center employees paid?
Mr. Niznik. So our call center employees are all salaried
employees who also do receive a discretionary bonus. It's based
on many factors that you'd expect someone who answers calls to
measure, so courtesy, returning calls, not missing calls.
But I think what's important is that no one that answers
these calls has any impact on the sort of care someone
receives. So when a patient comes to us, the doctors, the
nurses, the therapists, they make that determination. Really
just being measured how good of a job they do in explaining the
services that we offer and performing just the typical job
duties of answering calls.
Mrs. Brooks. But how would one call center employee get a
bonus versus another call center employee? How does that
information come to you or whoever their supervisor is as to
whether or not they receive a bonus? And is it monthly? How is
it determined?
Mr. Niznik. The bonus is monthly. And, again, it is
discretionary. It's based on maybe 7, 8, 10--it's based on a
list of factors that I provided in my written testimony. But
you measure things like do they answer the call? Have they
missed calls? Are they helpful? When the managers walk around
and hear a call, are they being polite? Are they knowledgeable
in the program? So all these factors are relevant in
determining is the person answering the call doing a good job.
Mrs. Brooks. OK. Mr. Mishek, are your call center people
paid?
Mr. Mishek. Our call center employees have always been
salaried?
Mrs. Brooks. Without bonuses?
Mr. Mishek. Correct.
Mrs. Brooks. Are there any minimum admissions goals for any
employees, kind of like sales quotas?
Mr. Mishek. No.
Mrs. Brooks. Mr. Cartwright?
Mr. Cartwright. Today, no.
Mrs. Brooks. OK. There have been in the past, but there are
not any longer?
Mr. Cartwright. Yes, ma'am. Again, I go back to the State
law in Tennessee, and we'd love to see that nationwide.
Mrs. Brooks. OK. Thank you.
Mr. Niznik, are there any imposed minimum admission goals?
Mr. Niznik. There's no minimum admission goals per person,
but collectively as a group, we want to make sure that people
answering the calls are doing a good job. And like I said in my
oral testimony, that like a receptionist in a doctor's office,
you want to make sure the person answering your questions is
being polite and doing a good job.
Mrs. Brooks. I'm sorry. My time is up, and I may submit a
couple of more written questions. Thank you. Thanks for your
work.
Mr. Harper. The gentlewoman yields back.
The chair will now recognize the gentleman from New York,
Mr. Collins, for 5 minutes.
Mr. Collins. Thank you, Mr. Chairman.
And the witnesses, it's an intriguing hearing because this
problem is almost insidious in its nature and it's almost hard
to begin. Let's start with the Federal regulations versus
Tennessee.
Mr. Mishek, you pretty much were calling on Congress to do
something and to call on the FTC to regulate.
Mr. Mishek. That's correct.
Mr. Collins. Maybe quickly, if I could ask the other
witnesses, do you agree that this situation we need--in this
case, Mr. Cartwright, you talked about Federal law versus State
law, which is popping up here or there, you believe this is a
place the Federal Government should step in and broadly
regulate what's going on, especially in the advertising area?
Mr. Cartwright. I do. I think there are existing FTC laws
that get to this, that need to be enforced. But I also think
your attention to this is much welcomed.
Mr. Collins. Yes.
Mr. Niznik. I think it's important that, just broadly, all
providers are transparent in the service they offer, that when
someone receives a call, they identify themselves. So I think,
even though we practice that in all of our facilities, even the
States where there isn't necessarily regulation, I think it
would be helpful. And I think equally as important would be
regulation that would look at standardizing care so that
providers----
Mr. Collins. But you're talking about in Federal--but
you're saying some States aren't doing anything, others,
Tennessee, may be doing a lot----
Mr. Niznik. Right.
Mr. Collins [continuing]. In which case you're saying the
Federal Government, in this case, should step in. We're always
somewhat cautious about Federal versus States' rights and so
forth, but it's sounding like, in this instance, you're calling
for the Federal Government to step in?
Mr. Niznik. Right. Because, for example, the standard of
care, there isn't a national one that's consistent from
provider to provider. So even as a facility, we defer to the
professional judgment of our doctors and clinicians, but I
think it would be better if they knew exactly what was, at
least at a minimum level, expected from them.
Mr. Collins. Mr. Cartwright.
Mr. Cartwright. I do think we need Federal intervention and
not just in marketing practices. We have a similar issue
related to licensure. Licensure standards in the State of
Minnesota or the State of Tennessee or the State of California
can be completely different where, for example, out in
California, in six-bed houses, you could be doing detox
services. We both, Mishek and myself, through our organizations
have CDRHs. They're hospitals for detoxification services. So
we should have some standardizations across the country.
One of the difficulties is we have 19,000 different
treatment centers across the United States with an annual
budget of about $5 million. We've never really caught the
attention of the Federal Government or even the healthcare
system. And today we do, right. We have people dying in the
streets all over this country, and we really do need to do
something about this.
And I'm very impressed with Congress in respect to what all
you all have done over the last 2 years on this issue. But now
I think we're starting to get to the things that Mr. Ventrell,
Mishek, myself want to see, and that's consistency around
advertising and marketing, but also consistency around quality
of care and licensure standards.
Thank you.
Mr. Collins. Mr. Brian.
Mr. Brian. From the advertisement perspective, I couldn't
agree more. We want nothing more, wanted nothing more than to
work with great centers that were licensed to do what they were
tasked to do. And I think that the ultimate underlying message
that I would like to leave is that people will search however
they choose to search, not how we think might be most
appropriate for them to search. So if they decide to go online,
they're going to go online. That's what they're going to do.
And so if we are holding our treatment programs to a higher
standard and ultimately the licensure required for them, I
think we'll be in much better shape regardless of who's on the
other end of the phone call.
Mr. Collins. Dr. Stoller.
Dr. Stoller. I'm afraid my work doesn't overlap advertising
enough to render a very informed opinion, but what I would say
is that access is very important. And I really appreciate the
work that the Congress has done to increase access, for
example, through Medicare reimbursement for opioid treatment
programs and anything else that could be done to make sure that
treatment is accessible and that parity is enforced.
Mr. Collins. So, Mr. Ventrell, finishing with you, NAATP is
the organization that is certifying and riding herd on these.
Is that organization well known like almost we think of the
Good Housekeeping Seal or something as in the vernacular?
Somebody searching would know, I've got to start with do I see
NAATP stamp of approval?
Mr. Ventrell. Well, I would hope so. And that certainly
would be----
Mr. Collins. Or is there work to be done there?
Mr. Ventrell. There is work to be done, Congressman, as is
demonstrated by the fact that we removed certain members so
that we could have a moral high ground in order to say, look,
if you want to be a member of the society, you have to follow
these rules.
So NAATP has been in existence for 40 years, so certainly
we're the longstanding trade association. I think that what you
will find as this process develops and we continue to
articulate best practices, that that is, in fact, the case,
that you need to be part of this national association and that
demonstrates a meaningful----
Mr. Collins. That would certainly be one way to weed out
the very bad actors because they're not part of the NAATP. So
we'd encourage you to continue to promote your brand.
Mr. Ventrell. Thank you.
Mr. Collins. With that, Mr. Chairman, I yield back.
Mr. Harper. The gentleman yields back.
The chair will now recognize the gentleman from
Pennsylvania, Mr. Costello, for 5 minutes.
Mr. Costello. Thank you, Mr. Chairman.
Mr. Brian, information your company provided committee
staff as well as your testimony indicates you routed more than
519,000 calls to treatment providers from December 2014 to the
present. Can you describe how those calls were generated?
Mr. Brian. Yes, sir, of course. We work with third-party
media agencies that operate in television, radio, search engine
advertising, amongst other avenues, and they generate--in
advertisement, typically it would be in the form of a help-line
related call that clearly indicates that their call will be
routed to a treatment center who pays to receive that phone
call. That call is then routed directly to the treatment center
through our platform, never stopping with us.
Mr. Costello. Contractually, do you have any approval over
the type of language that they utilize in their advertising in
order to generate that call?
Mr. Brian. Yes, sir. Indirectly, we have what we call our
marketing standards and practices attestation form, which
allows and provides them a very clear guideline of what we
allow and what we don't allow, most of which is congruent and
consistent with the same dialogue that we've had today.
Mr. Costello. Do you pre-approve that?
Mr. Brian. Not in all instances, but in most instances,
yes.
Mr. Costello. Have you ever had occasion to tell them to
remove a particular type of advertisement that did not accord
with those guidelines that you just referenced?
Mr. Brian. Yes, sir.
Mr. Costello. How much did you pay per call?
Mr. Brian. It would vary depending on the type of call. It
would range anywhere from $10, $15, $20 dollars on up to $60 or
$70, depending on how the call was originated.
Mr. Costello. How did treatment facilities find Redwood?
Mr. Brian. We participated in numerous trade shows,
conferences. I've spoken at several of these conferences, and
ultimately the organizations would find us typically through
that. We also had a strong web presence where we would
advertise directly to the treatment programs through our
website, which was treatmentcalls.com.
Mr. Costello. So did Redwood find the facilities online?
Mr. Brian. In some instances, yes, sir. Not in all
instances.
Mr. Costello. OK. Let me shift gears. This is for everyone
but Mr. Ventrell. I want to talk about success rates, because
in a lot of these advertisements you hear talk of there being a
successful treatment. We don't necessarily know what success
means.
So for each of you, what is your facility's success rate,
and how do you define success? Is it admission to your
facility? Completion of the program? Maintaining sobriety for a
month? Six months? One year? Five years? Starting with Mr.
Mishek.
Mr. Mishek. Thank you, Congressman. First of all, we don't
use that word, ``success.'' It's outcomes. This is a chronic
disease. You're going to have it for your lifetime. Hopefully,
you are in recovery and are happy, joyous, and free, as they
say in the big book.
We measure, as I said earlier, outcomes after 1 year of
being with us, whatever point you leave us, and----
Mr. Costello. Do you list that in your advertisement at
all, what's your outcome----
Mr. Mishek. We don't advertise it.
Mr. Costello. OK. And I want to hone in on the
advertisement and the use of the word ``success'' or anything
related thereto. Mr. Cartwright.
Mr. Cartwright. We don't use success rate on our
advertising. We conducted an outcome study that we've published
and put out there just recently over the last several months
where 4,000 patients went through that, that I'm very, very
pleased and proud of. But that doesn't encompass all of our
folks that are going through treatment annually.
Mr. Costello. Mr. Niznik.
Mr. Niznik. We don't advertise what our success rate is or
define it in any of our ads.
Mr. Brian. We don't have treatment centers at all----
Mr. Costello. Right.
Mr. Brian [continuing]. So we don't have success rates.
Mr. Costello. Dr. Stoller.
Dr. Stoller. Our position is similar to Mr. Mishek's. We
measure outcome over a continual time period.
Mr. Costello. Mr. Mishek, share with me some of the other
challenges in tracking success within the substance abuse
industry.
Mr. Mishek. Well, again, success for us is lifetime
recovery. It's a chronic disease. One of the unfortunate
features of it being a chronic disease is people relapse.
People come back to treatment often many times. It's important
never to give up hope, to bring them back, get them back in the
continuum.
So success for us are things like, yes, completion of a
particular episode of care is really important; participating
in recovery management is really important; making it to 12-
step meetings, if that's the route you're going, is really,
really important. Those are the things that we really focus on
and those are the things we look to for success. I hope that
answers your question.
Mr. Costello. It does. Thank you.
I yield back.
Mr. Harper. The gentleman yields back.
The chair will now recognize the gentleman from Georgia,
Mr. Carter, for 5 minutes.
Mr. Carter. Thank you all for being here. Very important
subject. I've always described the opioid epidemic as being two
types of problems: One is, how do we control that what I
consider to be the tangible part, how do we control the number
of pills out there, the number of prescriptions; and two, the
intangible, and that is, what do we do with those 2.5 million
people who are currently addicted? How do we help them? That's
why you're here today because we need answers to that. That's
very difficult.
I'll start with you, Mr. Brian, and ask you this: Are you
familiar with the Addiction Network?
Mr. Brian. Yes, sir.
Mr. Carter. You are familiar with that? As I understand
that features a gentleman, a bearded gentleman in blue scrubs
saying call this number and you can get help. And is that your
company doing that or what?
Mr. Brian. It's not our company doing that, sir. We----
Mr. Carter. It's not your company doing it?
Mr. Brian. No, sir.
Mr. Carter. OK. So you have a list of companies that you
refer people to,
Mr. Brian. Yes.
Mr. Carter. Is that correct?
Mr. Brian. Yes, sir.
Mr. Carter. OK. What are the qualifications for a company
to be on that list?
Mr. Brian. Licensed in the State that they are----
Mr. Carter. Just licensed.
Mr. Brian. Yes.
Mr. Carter. Anything else?
Mr. Brian. Not with us, no.
Mr. Carter. Not with you.
What about you, Mr. Cartwright? You do the same thing, the
same business model. Is that correct?
Mr. Cartwright. A little bit different business model, sir.
Mr. Carter. OK. Very quickly, how different?
Mr. Cartwright. It's an advertising model.
Mr. Carter. It's an advertising model.
Mr. Cartwright. They don't call into our call center, and
then we don't refer them out.
Mr. Carter. OK. Do you have any requirements for them to be
on there?
Mr. Cartwright. We do. They have to be part of SAMHSA's
website----
Mr. Carter. OK. You mentioned that earlier.
Mr. Cartwright [continuing]. Which I'm assuming is vetted.
They have to be a licensed organization with CARF or JCAHO
accreditation.
Mr. Carter. Do you take into consideration, as my colleague
just asked, outcomes? Do you take that into consideration? Do
you ask those companies before you put them on your list, tell
me about your outcomes?
Mr. Cartwright. We do not.
Mr. Carter. You do not.
Mr. Brian, do you?
Mr. Brian. No, sir.
Mr. Carter. You do not?
Mr. Brian. No, sir.
Mr. Carter. So the outcomes has nothing to do with it.
They're just on the list.
When you refer, Mr. Cartwright, a patient to one of these
clinics, if you will, do they reimburse you for that?
Mr. Cartwright. No, sir, we don't refer people to clinics.
Mr. Carter. OK. When you refer people----
Mr. Cartwright. Correct.
Mr. Carter [continuing]. The company that you refer them
to?
Mr. Cartwright. If a call comes into our call center and we
refer it out to another facility, no, we would never take money
from them.
Mr. Carter. Does that facility reimburse you in any way at
all?
Mr. Cartwright. No, sir.
Mr. Carter. How do you make money then?
Mr. Cartwright. We don't make money from that at all.
Mr. Carter. Where do you make your money?
Mr. Cartwright. We are a treatment organization. We have 39
treatment centers in 9 States, and that's where we make the
bulk of our revenue, just like Hazelden Betty Ford Center.
Mr. Carter. Do you refer patients to other facilities
besides yours?
Mr. Cartwright. If somebody calls into our call center and
they're in a local area and we don't have a treatment center in
that area, absolutely, we'd refer them to the SAMHSA website.
We may even walk through that SAMHSA website with them and let
them know about local facilities in that area, but we would
never take money from them.
Mr. Carter. OK. What about you, Mr. Brian, when you give a
referral to another clinic, do you get reimbursed?
Mr. Brian. We don't make any referrals. So we don't have a
call center that accepts phone calls.
Mr. Carter. You don't have a call center. So when you route
them----
Mr. Brian. Yes, sir.
Mr. Carter [continuing]. To that clinic----
Mr. Brian. Yes, sir.
Mr. Carter [continuing]. Do they reimburse you any at all
for that referral, if you will?
Mr. Brian. For the phone call, we receive compensation for
it, yes, sir.
Mr. Carter. Do you receive it from the clinic?
Mr. Brian. For the phone call itself, yes.
Mr. Carter. OK. So, again, you don't take into
consideration, there's no prerequisites for that company, for
that clinic to be on your list. You just simply go in and list
them.
Let me ask you something. When you make these kind of
referrals, if you will, do you interview the patient? Do you
sit there and say, OK, tell me what your problem is, tell me
what your pay type is, tell me what you're looking for? Do you
do anything like that or you just say, hey, this is in your
area, this is who we recommend?
Mr. Brian. We don't recommend. We don't talk to the client
ever in that engagement at all. We don't have any interaction
at all with the prospective----
Mr. Carter. Then how do you know who to refer them to?
Mr. Brian. We refer them to a licensed facility, sir. The
prerequisite to work with us, if it was good enough for the
State to issue licensure for them, that's our prerequisite in
order to do business with us.
Mr. Carter. OK. Do you think that serves the best interest
of the patient?
Mr. Brian. I believe it serves the law in the State of
Florida that I live and work in. And I would welcome this
conversation. I believe that a lot more can be done to route
these calls to the appropriate facility.
Mr. Carter. I would think so.
Mr. Brian. I agree.
Mr. Carter. I would think if I called that, I'd want to
have some information before I said, OK, this is where you need
to go.
Mr. Cartwright, you've referred to State laws that have
been passed. Have they addressed any of that?
Mr. Cartwright. I think what you're getting at is the
quality of the facility that you're referring someone to.
Mr. Carter. The quality and the type of facility. If I say,
I've got an addiction and I'm looking for something that's
faith based and I need your recommendation, do you take into
consideration anything like that?
Mr. Cartwright. Again, if Congress would support something
like that through SAMHSA, I think that would be excellent. I do
think that this is where it needs to land is in Congress' lap,
because each of the States are so different in terms of how
they license----
Mr. Carter. OK. I'm out of time. But listen, we're very
responsible people up here, and we want to do and we're going
to do what's right. But we also look to you to have a certain
level of responsibility as well. So don't always look to
Congress as being the ultimate answer here, OK.
Thank you very much, Mr. Chairman. I yield back.
Mr. Harper. The gentleman yields back.
The chair will now recognize the gentleman from Florida,
Mr. Bilirakis, for 5 minutes.
Mr. Bilirakis. Thank you very much.
Thank you for your testimony as well. And thank you, Mr.
Chairman, for holding this very important hearing.
If there's one thing that's been made clear in today's
hearing is that there is a lack of clarity on how individuals
can ensure they are seeking care that will best meet their
needs. I want to better understand how we can serve our
constituents by creating a clear path forward here.
Mr. Ventrell, does the Association have a definition of
what quality care is? And then, what resources exist for the
consumers to seek out quality care?
Mr. Ventrell. Thank you, Congressman. Yes. As part of the
quality assurance initiative, NAATP developed a research called
the NAATP Guide to Treatment Program Selection. It's a
comprehensive consumer tool, also useful for the field, that
provides red flags and positive references.
It is premised on four principles. Addiction treatment is
healthcare and should be chosen as such. There are knowable
indicia of quality of care. It's not a mystery. We know what
produces quality care. Third, there needs to be transparency in
the marketing process. And fourth, the institution that you go
to should adhere to a recognized code of ethics.
Mr. Bilirakis. Let me ask you a question, and maybe this is
for the panel as well. Would a star rating system be very
helpful? Because that kind of simplifies it in certain areas
rating the particular facility. I think that that might be
simpler. Again, these are their loved ones and they want to
make the right decision for them.
So if anybody wants to chime in on that, I'd appreciate an
answer.
Yes, sir.
Mr. Ventrell. May I, sir? It's an attractive solution, but
I think it's a dangerous one. Things are more complicated than
ranking by star. I don't think that that's achievable in a
reliable way.
Mr. Bilirakis. Well, we do it for nursing homes. I
distinguish that a nursing home as opposed to a substance use
disorder facility or mental health facility.
Mr. Ventrell. Yes. Thank you. The floor needs to be clearly
established in order for a process like that to work. In other
words, nursing homes must exist, I believe, at a certain level
of quality before you can start to talk about that.
What I propose, or what we propose or suggest instead is
that the floor, the basic operational requirements should be
regulated sufficiently such that if you read, if they are, and
then you read the services offered, the consumer can rely on
that, and a star system wouldn't be necessary.
Mr. Bilirakis. OK. I just want to make it clear and less
complicated for the consumer. And I want them to know where to
turn to, where to find this information out. I want it to be
easily accessible.
Let's see, a big concern that this committee has is
ensuring that when an individual or their loved one is seeking
substance use disorder treatment, they know what things to look
for. And you mentioned the flags. What things to avoid, again,
to best protect themselves from falling prey to any deceptive
marketing schemes that may be out there, and there are plenty
out there.
Could you identify a few red flags that individual should
be on the lookout for when seeking care, as well as a few green
flags that might indicate that a treatment center provides
quality care?
For example, some reports suggest paying attention to
whether or not the facility lists a staff page or asking the
person who answers the phone whether or not they are actually
at the treatment center.
So, Mr. Ventrell, you can start, if you like.
Mr. Ventrell. Sure. As part of the same document which I
have referenced, we've listed red flags and questions to ask.
Red flags generally that we believe should be observed are
generic websites, call directories, or websites offering
treatment placement. Many of these make referrals based on
business relationships. That's the problem.
Questions to ask include licensing, accreditation. It's all
based on transparency. We would like them obviously to be
members of our national association. How long has the facility
been in operation? Who are the staff? What levels of care are
provided? What are the placement criteria? What is your
procedure for the continuum of care as the chronic disease
exists one's entire life? The list goes on, and I'm happy to
provide that. In fact, it is part of the record.
Mr. Bilirakis. OK. Let me ask one more question. I do have
several here, but with regard to payment, because it's
difficult for a person to--obviously, you want to make the
right decision, OK, but also, how many treatment centers take
private insurance? What's a percentage?
Whoever wants to answer that question would be fine with
me, or you can even just talk about your particular treatment
center, whether that center accepts private insurance.
Mr. Cartwright. Congressman, thank you very much, and going
back to your previous question as well. I do think that the
addiction treatment industry is very similar to the nursing
home industry. It's a maturing industry that could benefit from
a star system like you were referring to. I think it's very,
very similar to the nursing home space where Federal regulation
needs to be tighter across the board. That would be my personal
opinion. So I really appreciate you bringing that up.
Mr. Bilirakis. Oh, absolutely. Thank you. Thank you for
your opinion.
Mr. Mishek. If I could talk about insurance.
Mr. Bilirakis. I guess I probably have to yield back.
Thank you very much. If maybe you can have some time, Mr.
Chairman, for him to answer the question. But I'll yield back.
Mr. Harper. The gentleman yields back, and I've got a
couple of followup things, but I'll recognize Ranking Member
DeGette for purposes of entering a document.
Ms. DeGette. Mr. Chairman, thank you.
We just received a letter from the Federal Trade Commission
regarding this issue. And what Commissioner Chopra talks about
in this letter is the for-profit treatment centers and what
that can do in terms of driving up costs for insurance and for
Medicare and Medicaid programs, as well as cost for patients
out of their pockets.
The letter also cautions about the deceptive trade
practices in trying to match individuals to centers and the
advertising. And it finally urges this committee to take a
close look at the advertising and marketing practices in the
industry to make sure that incentive compensation practices for
employees and operators of treatment centers, as well as
financial conflicts of interests with other firms, are
addressed.
And so I'd like unanimous consent to enter this into the
record so that we can continue to look at these issues as we
continue our investigation.
Mr. Harper. Without objection, so entered.
[The information appears at the conclusion of the hearing.]
Mr. Harper. Any other comments, Ms. DeGette?
Ms. DeGette. No.
Mr. Harper. I had a couple of followup items I just wanted
to touch on.
Mr. Cartwright, how do companies and their phone numbers
end up on their website?
And I ask that because we understand that there's at least
one phone number that doesn't call the named facility that it
is listed with. So how do companies and those phone numbers end
up on your websites?
Mr. Cartwright. We utilize the SAMHSA website in terms of
the listings on there. And so if it's not been updated through
SAMHSA, maybe we didn't update that. I'd love to know the phone
number that didn't go through correctly. We would certainly
like to look at that.
Mr. Harper. Sure. We will make sure you have that info to
clear that up.
Also, Mr. Cartwright, I know that you do operate, a
portfolio of websites under your Recovery Brands business line.
Are you able to tell us how many websites are operated under
Recovery Brands and give us that information today?
Mr. Cartwright. I can get you the exact websites
themselves. I think we've been asked by staff to provide that,
and we can certainly do that.
Mr. Harper. That would be very helpful.
One issue that this committee has explored, obviously, is
abuse of billing practices, especially with urine drug testing.
For example, the reports of clinics and labs charging more than
$4,000 for a single urine test and for treatment facilities to
test individuals two or three times a week.
So for Mr. Mishek, Mr. Niznik, and Mr. Cartwright, can you
explain how often your facilities test patients and what the
average cost is? And answer, if you can, as quickly as you can.
Mr. Mishek. Sure. We do a urine drug screen upon admission
for any level of care: Residential, day treatment, intensive
outpatient. During the course, the patient may get two or three
additional tests, depending on whether they came up on the
randomized thing we do or whether it was for cause.
We don't charge. We have no revenue from drug testing. The
cost that we incur is about $20 a test roughly. It's very, very
low cost.
Mr. Harper. Are those tests performed at your facility or
sent out to a lab?
Mr. Mishek. They are sent out to a national lab.
Mr. Harper. OK. Mr. Cartwright.
Mr. Cartwright. Very similar. We use the same guidelines
just like Hazelden Betty Ford Center, very similar in terms of
intake. We generate about $50 for a urine sample, but we also
own and operate our own laboratories.Two of them, one in
Tennessee and one in the State of Louisiana.
Mr. Harper. So those are sent out to those facilities for
testing?
Mr. Cartwright. Correct.
Mr. Harper. OK. Mr. Niznik.
Mr. Niznik. We also test upon admission. And then on
average, it's about 1 \1/2\ times per week, but it's generally
in the discretion of the medical doctor that's overseeing the
care of the patient to order whatever test they think is
medically necessary. We send it out to the lab that we operate
in Florida.
Mr. Harper. Is your mic on?
Mr. Niznik. Yes.
Mr. Harper. How many labs and what do you charge, that you
own.
Mr. Niznik. We own one lab. We operate one lab. It services
all of our facilities. And our average, I think, reimbursement
is somewhere around $200 to $300.
Mr. Harper. OK. I'll yield to Ms. DeGette for a followup.
Ms. DeGette. So you say that you test on the average of 1
\1/2\ times per week. You send it out to your lab. Are you then
billing the insurance the $200 to $300?
Mr. Niznik. Yes, that's the reimbursement we receive from
the--no, that's the reimbursement we receive from the insurance
company.
Ms. DeGette. Right. So you're billing the insurance $200 to
$300 per 1 \1/2\ times a week, whereas these other facilities
aren't charging their people anything.
Thank you, Mr. Chairman.
Mr. Harper. Final question, and Mr. Cartwright, I pulled up
drugabuse.com, which is yours. And going through the website it
has lots of information. It talks about the opioid crisis. It
has an 800 number. ``It's not too late to turn your life
around,'' ``overcoming your addiction.''
While we don't measure success or outcome, it certainly
might imply to one, that I will get that outcome if I go there.
But you have to go to the small ``I'' that I asked Mr. Ventrell
about earlier to find out that your visit will be answered by
American Addiction Centers, AAC, or a paid sponsor.
Why wouldn't you just list that information at the top of
your web page? You have to go hunt for that, either under the
number or other things. Why wouldn't you do that?
Mr. Cartwright. Again, our business model is very similar
to WebMD. If you'd like us to change it and put it at the very
top, I'm happy to do----
Mr. Harper. I'm not asking about WebMD. I'm asking you, if
we're talking about transparency and what we're looking at here
so that it's nothing is viewed to be deceptive, wouldn't it be
easy just at the beginning of your web page to say that
information?
Mr. Cartwright. Yes, sir, we can do that.
Mr. Harper. Who are the paid sponsors?
Mr. Cartwright. It's the advertisers that we were referring
to earlier in the conversation.
Mr. Harper. Who determines on that call whether or not it
goes to AAC or to a paid sponsor?
Mr. Cartwright. All of the phone calls that are coming in
through the 1-800 number that is like that, they all come to
American Addiction Centers.
Mr. Harper. OK.
Mr. Cartwright. The paid sponsors is referring to if they
have an ad, and it's very clear who that company is.
Mr. Harper. Do you send anything to an unpaid sponsor? Or
is there such a thing as unpaid sponsor?
Mr. Cartwright. Yes, there is.
Mr. Harper. OK. And how do you rotate--a call comes in, how
do you determine who it goes to?
Mr. Cartwright. It's not a call that comes in. If they're
looking on the website, and if you go down through the website
and you look in Denver, Colorado, it would have all the local
providers in that area. They wouldn't have to pay for that
listing. It would have all of them listed there. All the not-
for-profit agencies, all the hospitals, treatment centers.
Mr. Harper. But if I call that 800 number, or 877 number,
whatever it is, if I were to call that, it would go to a
facility or go to the hotline?
Mr. Cartwright. That would only come to American Addiction
Centers.
Mr. Harper. OK. All right. I got it.
I want to thank everyone for their testimony. This is an
issue that we're obviously concerned about, but I thank you for
your time, your patience, for your responses.
I would remind members that they have 10 business days to
submit questions for the record. And I would ask the witnesses
that you respond as promptly as possible when you get such
questions.
With that, the subcommittee is adjourned.
[Whereupon, at 12:10 p.m., the subcommittee was adjourned.]
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